NPIMap

Organization Active NPI

Lifetime Dental Care of Illinois, PC

Doing business as Dental Group of Rockford

  • General Practice Dentistry
  • Rockford, IL
National Provider Identifier
1902028178
Registry record updated Mar 17, 2010
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
Dental Group of Rockford
Practice address
3065 N Perryville Rd Unit 125
Rockford, IL 61114-8036
Phone
(815) 637-2273
Fax
(815) 637-2466
NPI assigned
May 3, 2007
Last updated
Mar 17, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2010

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 NU Primary

Addresses

Primary practice location

3065 N Perryville Rd Unit 125
Rockford, IL 61114-8036

Mailing address

3065 N Perryville Rd Unit 125
Rockford, IL 61114-8036
Phone (815) 637-2273

Other names 1

  • Dental Group of Rockford 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

3065 N Perryville Rd
Unit 125
Rockford, IL 61114
Phone (815) 637-2273

Practitioners & affiliated clinicians

Practitioners 2

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": "1268784000000",
    "number": "1902028178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3065 N PERRYVILLE RD UNIT 125",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148036",
            "telephone_number": "815-637-2273",
            "fax_number": "815-637-2466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3065 N PERRYVILLE RD UNIT 125",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148036",
            "telephone_number": "815-637-2273",
            "fax_number": "815-637-2466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME DENTAL CARE OF ILLINOIS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2010-03-17",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Group of Rockford",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2010; 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.