LIFETIME DENTAL CARE OF ILLINOIS, PC (NPI# 1023230281) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023230281 |
| Entity Type | Organization |
| Organization Name | LIFETIME DENTAL CARE OF ILLINOIS, PC |
| Other Organization Name | DENTAL GROUP OF CARBONDALE |
| Practice Address |
1001 E Main Carbondale IL 62901 |
| Practice Telephone | 6185492273 |
| Practice Fax Number | 6183510212 |
| Mailing Telephone | 6185492273 |
| Mailing Fax Number | 6183510212 |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | AMY KROEGER (INS COOD) |
| Authorized Official Telephone | 2175405100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Dental Group of Carbondale | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487867750 | Lifetime Dental Care of Illinois, PC | Dentist | 1366 E Main, Carbondale, IL 62901 | 2007-05-07 |
| 1689887952 | Lifetime Dental Care of Illinois, PC | Dentist | 2633 Chatham Road, Suite A, Springfield, IL 62704 | 2007-05-07 |
| 1700099066 | Lifetime Dental Care of Illinois, PC | Dentist | 2943 W White Oaks Drive, Springfield, IL 62704 | 2007-05-07 |
| 1659583656 | Lifetime Dental Care of Illinois, PC | Dentist | 700 N Keller, Effingham, IL 62401 | 2007-05-04 |
| 1720290638 | Lifetime Dental Care of Illinois, PC | Dentist | 411 Keokuk Street, Lincoln, IL 62656 | 2007-05-04 |
| 1487866919 | Lifetime Dental Care of Illinois, PC | Dentist | 7310 N. Villa Lake Drive, Suite B, Peoria, IL 61614 | 2007-05-04 |
| 1376765776 | Lifetime Dental Care of Illinois, PC | Dentist | 703b S Neil, Champaign, IL 61820 | 2007-05-03 |
| 1396967741 | Lifetime Dental Care of Illinois, PC | Dentist | 1200 W Jackson, Macomb, IL 61455 | 2007-05-03 |
| 1801018270 | Lifetime Dental Care of Illinois, PC | Dentist | 907 W Marketview, Unit 11, Champaign, IL 61822 | 2007-05-03 |
| 1801018197 | Lifetime Dental Care of Illinois, PC | Dentist | 2707 Sycamore Road, Dekalb, IL 60115 | 2007-05-03 |
| Street Address |
1001 E MAIN |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| Find all providers in zip 62901 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487049698 | Mark A Cook Dds PC | Dentist | 60 S 8th St Suite 201, Carbondale, CO 81623-1929 | 2015-04-03 |
| 1427357631 | Dental Safari Company, Ltd | Dentist | 800 E Walnut St, Suite A, Carbondale, IL 62901-3142 | 2011-03-28 |
| 1053647032 | Ralph Kimbrough | Dentist | 402 S. Lewis Ln, Carbondale, IL 62901-3547 | 2009-10-26 |
| 1487810461 | S. Michael Vancil | Dentist | 1255 Cedar Ct, Carbondale, IL 62901-5335 | 2008-07-30 |
| 1477716926 | Alice A Kaniff | Dentist | 326 Highway 133 Ste 270h, Carbondale, CO 81623-2510 | 2008-07-04 |
| 1487867750 | Lifetime Dental Care of Illinois, PC | Dentist | 1366 E Main, Carbondale, IL 62901 | 2007-05-07 |
| 1831259175 | Gerald G Salko | Dentist | 59 7th Ave, Carbondale, PA 18407-2320 | 2006-12-09 |
| 1093883647 | Dianna Gail Gaultney | Dentist | 207 N University Ave, Carbondale, IL 62901-1445 | 2006-12-01 |
| 1982774659 | Dominic Cittadino | Dentist | 305 S Oakland Ave, Carbondale, IL 62901-2545 | 2006-11-09 |
| 1376613539 | Daniel Lee Massie | Dentist | 200 N Giant City Rd, Carbondale, IL 62902-6410 | 2006-11-08 |
| Find all providers in CARBONDALE | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
Please comment or provide details below to improve the information on LIFETIME DENTAL CARE OF ILLINOIS, PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.