NPIMap

Organization Active NPI

Lifetime Dental Care of Illinois, PC

  • General Practice Dentistry
  • Springfield, IL
National Provider Identifier
1720200074
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 ILLINOIS, PC
Practice address
3124 Montvale Drive
Springfield, IL 62704
Phone
(217) 546-8777
Fax
(217) 546-9547
NPI assigned
May 3, 2007
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

3124 Montvale Drive
Springfield, IL 62704

Mailing address

3124 Montvale Drive
Springfield, IL 62704
Phone (217) 546-8777

Other names 1

  • Montvale 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

3124 Montvale Dr
Springfield, IL 62704
Phone (217) 546-8777

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1720200074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3124 MONTVALE DRIVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "62704",
            "telephone_number": "217-546-8777",
            "fax_number": "217-546-9547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3124 MONTVALE DRIVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "62704",
            "telephone_number": "217-546-8777",
            "fax_number": "217-546-9547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME DENTAL CARE OF ILLINOIS, 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": "Montvale Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, IL

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.