NPIMap

Organization Active NPI

Lifetime Dental Care of Illinois, PC

Doing business as Macomb Dental Center

  • General Practice Dentistry
  • Macomb, IL
National Provider Identifier
1396967741
Registry record updated Oct 13, 2025
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
Macomb Dental Center
Practice address
1200 W Jackson
Macomb, IL 61455
Phone
(309) 836-6688
Fax
(309) 836-6119
NPI assigned
May 3, 2007
Last updated
Oct 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2025

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 DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1200 W Jackson
Macomb, IL 61455

Mailing address

1200 W Jackson St Ste 5
Macomb, IL 61455-1175
Phone (309) 836-6688

Other names 1

  • Macomb Dental Center 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

Other organizations with this tax ID 21

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

View all 21

Locations

1200 W Jackson St
Macomb, IL 61455
Phone (309) 836-6688

1200 W Jackson St
Ste 5
Macomb, IL 61455

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": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760313600000",
    "number": "1396967741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W JACKSON ST STE 5",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614551175",
            "telephone_number": "309-836-6688",
            "fax_number": "309-836-6119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W JACKSON",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "61455",
            "telephone_number": "309-836-6688",
            "fax_number": "309-836-6119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME DENTAL CARE OF ILLINOIS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Macomb Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Macomb, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2025; 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.