LIFETIME DENTAL CARE OF ILLINOIS, PC (NPI# 1376765776) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376765776 |
| Entity Type | Organization |
| Organization Name | LIFETIME DENTAL CARE OF ILLINOIS, PC |
| Other Organization Name | CHAMPAIGN DENTAL GROUP |
| Practice Address |
703b S Neil Champaign IL 61820 |
| Practice Telephone | 2173982244 |
| Practice Fax Number | 2173989188 |
| Mailing Telephone | 2173982244 |
| Mailing Fax Number | 2173989188 |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | AMY KROEGER (INS COOD) |
| Authorized Official Telephone | 2175405100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Champaign Dental Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487867750 | Lifetime Dental Care of Illinois, PC | Dentist | 1366 E Main, Carbondale, IL 62901 | 2007-05-07 |
| 1689887952 | Lifetime Dental Care of Illinois, PC | Dentist | 2633 Chatham Road, Suite A, Springfield, IL 62704 | 2007-05-07 |
| 1700099066 | Lifetime Dental Care of Illinois, PC | Dentist | 2943 W White Oaks Drive, Springfield, IL 62704 | 2007-05-07 |
| 1659583656 | Lifetime Dental Care of Illinois, PC | Dentist | 700 N Keller, Effingham, IL 62401 | 2007-05-04 |
| 1720290638 | Lifetime Dental Care of Illinois, PC | Dentist | 411 Keokuk Street, Lincoln, IL 62656 | 2007-05-04 |
| 1487866919 | Lifetime Dental Care of Illinois, PC | Dentist | 7310 N. Villa Lake Drive, Suite B, Peoria, IL 61614 | 2007-05-04 |
| 1023230281 | Lifetime Dental Care of Illinois, PC | Dentist | 1001 E Main, Carbondale, IL 62901 | 2007-05-03 |
| 1396967741 | Lifetime Dental Care of Illinois, PC | Dentist | 1200 W Jackson, Macomb, IL 61455 | 2007-05-03 |
| 1801018270 | Lifetime Dental Care of Illinois, PC | Dentist | 907 W Marketview, Unit 11, Champaign, IL 61822 | 2007-05-03 |
| 1801018197 | Lifetime Dental Care of Illinois, PC | Dentist | 2707 Sycamore Road, Dekalb, IL 60115 | 2007-05-03 |
| Street Address |
703B S NEIL |
| City | CHAMPAIGN |
| State | IL |
| Zip Code | 61820 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982217345 | Costco Wholesale Corporation | Pharmacy | 2002 N. Neil St., Champaign, IL 61820 | 2020-08-26 |
| 1255963583 | Jamey Richard Bailey | Social Worker | 701 Devonshire Drive, Bldg C, Suite 206, C-6, Champaign, IL 61820 | 2020-02-05 |
| 1790247443 | Jason Abrams | Counselor | 201 W Springfield Ave., Suite 1002-1003, Champaign, IL 61820 | 2019-04-02 |
| 1184100273 | Janine Rafferty | Pharmacist | 2002 N Neil St, Champaign, IL 61820 | 2018-07-12 |
| 1417475070 | Brodbeck Counseling, PC | Community/Behavioral Health | 301 N. Neil Street Suite 323, Champaign, IL 61820 | 2017-09-05 |
| 1447773726 | Quanata M Pelmore | Nurse's Aide | 508 E. Vine St, Champaign, IL 61820 | 2017-07-19 |
| 1821518127 | Molly Mclay | Social Worker | 309 W Clark St., Champaign, IL 61820 | 2017-06-27 |
| 1396265849 | Lou Echols Chambers | Audiologist | 901 South Sixth Street, Chamapign, IL 61820 | 2017-06-26 |
| 1962874495 | Luciana Angelica Guardini | Social Worker | 100 North Chestnut Street, Suite 244, Champaign, IL 61820 | 2015-10-23 |
| 1538544465 | Cpo Services, Inc. | Prosthetic/Orthotic Supplier | 410 E University Ave Ste 105, Champaign, IL 61820 | 2015-07-21 |
| Find all providers in zip 61820 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295268019 | Mountain Bay Dental LLC | Dentist | 3510 Marianna Dr, Champaign, IL 61822-9502 | 2017-04-08 |
| 1982094462 | Familia Dental Champaign LLC | Dentist | 1907 W Spfld Ave, Champaign, IL 61821-3067 | 2015-02-04 |
| 1205245693 | Illini Smiles Dental Care PC | Dentist | 201 W Springfield Ave Ste 506, Champaign, IL 61820-6383 | 2014-08-11 |
| 1306152806 | Tania G Lodhi | Dentist | 1902 N Prospect Ave, Suite 1, Champaign, IL 61822-1411 | 2010-08-23 |
| 1154651628 | Michael R Ruffatto | Dentist | 1202 Harrington Dr, Champaign, IL 61821-6514 | 2010-01-06 |
| 1407005879 | Promise Healthcare Nfp | Dentist | 819 Bloomington Road, Champaign, IL 61820 | 2008-09-10 |
| 1851540330 | Central Illinois Oral and Maxiofacial Surgery, PC | Dentist | 14 E Anthony Dr Ste C, Champaign, IL 61820-2749 | 2008-09-09 |
| 1407002165 | Nikkole Patterson | Dentist | 3101 Village Office Pl, Champaign, IL 61822-7673 | 2008-08-13 |
| 1407010176 | Douglas M Wallen | Dentist | 2502 Galen Dr, Suite 103, Champaign, IL 61821-7045 | 2008-07-11 |
| 1275703175 | Thomas E. Standley, Dmd, PC | Dentist | 30 E Green St, Suite 1, Champaign, IL 61820-7905 | 2008-03-06 |
| Find all providers in CHAMPAIGN | ||||
Please comment or provide details below to improve the information on LIFETIME DENTAL CARE OF ILLINOIS, PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.