NPIMap

Organization Active NPI

Lifetime Dental Care of Illinois, PC

Doing business as Green Mount Family Dentistry

  • General Practice Dentistry
  • O'Fallon, IL
National Provider Identifier
1376756635
Registry record updated May 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LIFETIME DENTAL CARE OF ILLINOIS, PC
Doing business as
Green Mount Family Dentistry
Practice address
1490 North Greenmount Road
Suite a
Ofallon, IL 62269
Phone
(618) 622-9720
Fax
(618) 622-1700
NPI assigned
May 7, 2007
Last updated
May 21, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
LIFETIME DENTAL CARE OF ILLINOIS, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 21, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amy Kroeger
Title
Ins Cood
Phone
(217) 540-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

1490 North Greenmount Road
Suite a
Ofallon, IL 62269

Mailing address

1490 North Greenmount Road
Suite a
Ofallon, IL 62269
Phone (618) 622-9720

Other names 1

  • Green Mount Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lifetime Dental Care of Illinois PC22 organizations share this tax ID, including this one
Part of
Lifetime Dental Care of Illinois PC

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

1490 N Green Mount Rd
Ste A
O Fallon, IL 62269
Phone (618) 622-9720

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1376756635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1490 NORTH GREENMOUNT ROAD",
            "address_2": "SUITE A",
            "city": "OFALLON",
            "state": "IL",
            "postal_code": "62269",
            "telephone_number": "618-622-9720",
            "fax_number": "618-622-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 NORTH GREENMOUNT ROAD",
            "address_2": "SUITE A",
            "city": "OFALLON",
            "state": "IL",
            "postal_code": "62269",
            "telephone_number": "618-622-9720",
            "fax_number": "618-622-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME DENTAL CARE OF ILLINOIS, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFETIME DENTAL CARE OF ILLINOIS, PC",
        "enumeration_date": "2007-05-07",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "KROEGER",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "INS COOD",
        "authorized_official_telephone_number": "217-540-5100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Mount Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in O'Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.