NPIMap

Organization Active NPI

Lifetime Dental Care of Indiana, PC

Doing business as Complete Family Dental Care

  • General Practice Dentistry
  • Anderson, IN
National Provider Identifier
1619199221
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LIFETIME DENTAL CARE OF INDIANA, PC
Doing business as
Complete Family Dental Care
Practice address
777 Broadway
Suite a
Anderson, IN 46012
Phone
(765) 641-7930
Fax
(765) 641-7957
NPI assigned
May 3, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

777 Broadway
Suite a
Anderson, IN 46012

Mailing address

777 Broadway
Suite a
Anderson, IN 46012
Phone (765) 641-7930

Other names 1

  • Complete Family Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lifetime Dental Careof Indiana PC24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

Locations

777 Broadway St
Ste A
Anderson, IN 46012
Phone (765) 641-7930

Practitioners & affiliated clinicians

Practitioners 3

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": "1598054400000",
    "number": "1619199221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 BROADWAY",
            "address_2": "SUITE A",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "46012",
            "telephone_number": "765-641-7930",
            "fax_number": "765-641-7957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 BROADWAY",
            "address_2": "SUITE A",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "46012",
            "telephone_number": "765-641-7930",
            "fax_number": "765-641-7957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME DENTAL CARE OF INDIANA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-08-22",
        "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": "Complete Family Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anderson, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.