LIFETIME DENTAL CARE OF ILLINOIS, PC (NPI# 1396967741) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396967741 |
| Entity Type | Organization |
| Organization Name | LIFETIME DENTAL CARE OF ILLINOIS, PC |
| Other Organization Name | MACOMB DENTAL CENTER |
| Practice Address |
1200 W Jackson Macomb IL 61455 |
| Practice Telephone | 3098366688 |
| Practice Fax Number | 3098366119 |
| Mailing Telephone | 3098366688 |
| Mailing Fax Number | 3098366119 |
| 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 |
|---|---|
| Macomb Dental Center | 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 |
| 1376765776 | Lifetime Dental Care of Illinois, PC | Dentist | 703b S Neil, Champaign, IL 61820 | 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 |
1200 W JACKSON |
| City | MACOMB |
| State | IL |
| Zip Code | 61455 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043869944 | Wesley Village, Inc | Speech-Language Pathologist | 1200 East Grant Street, Macomb, IL 61455 | 2019-09-04 |
| 1780154013 | Hannah Lauren Bengtson | Optometrist | 820 E. Jackson St., Macomb, IL 61455 | 2018-11-29 |
| 1255832564 | Lifeguard Ambulance Service of Illinois Inc. | Ambulance | 219 W Jackson St, Macomb, IL 61455 | 2018-02-22 |
| 1821516816 | Michelle Deann Sargeant | Speech-Language Pathologist | 315 N. Bonham, Macomb, IL 61455 | 2017-08-30 |
| 1972020360 | Kara Marie Wright | Speech-Language Pathologist | 315 N. Bonham St., Macomb, IL 61455 | 2017-08-25 |
| 1720356504 | Dawn M. Kedzior | Social Worker | 103 South Johnson Street, Macomb, IL 61455 | 2011-12-07 |
| 1255632642 | Michael Kurt Sharp | Audiologist | Memorial Hall, Second Floor, W Murray St, Macomb, IL 61455 | 2010-11-16 |
| 1952538704 | Mary L. Smith | Developmental Therapist | 1 University Circle, Western Il Univ, Cntr for Best Practices In Early Childhood Education, Macomb, IL 61455 | 2009-06-19 |
| 1982857827 | Macomb Oncology Institute Ltd | Radiology | 401 East Grant Street, Macomb, IL 61455 | 2008-10-23 |
| 1245488345 | Sonja E Schmidt | Social Worker | 119 Wetzel Hall, Western Illinois University, Macomb, IL 61455 | 2008-09-03 |
| Find all providers in zip 61455 | ||||
| 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 |
|---|---|---|---|---|
| 1013432707 | Umair Waheed | Dentist | 22537 Hall Rd, Macomb, MI 48042-5219 | 2017-08-03 |
| 1134333578 | Richard Henry Poupard | Dentist | 17933 Hall Road, Macomb, MI 48044-4557 | 2007-05-09 |
| 1942412994 | James William Hilton | Dentist | 45245 Romeo Plank Rd, Ste B, Macomb, MI 48044-4232 | 2007-05-03 |
| 1063634061 | Tonny Jill Williamson | Dentist | 528 W. Jackson St., Macomb, IL 61455 | 2007-05-02 |
| 1659596393 | Jon Karl Dively | Dentist | 4 Doctors Ln, Macomb, IL 61455-3376 | 2007-04-16 |
| 1265551535 | Matthew Scott Mcclure | Dentist | 1508 E Jackson St, Macomb, IL 61455-2529 | 2007-03-28 |
| 1720131402 | Jerald A. Spolar | Dentist | 528 W Jackson St, Macomb, IL 61455-2008 | 2007-01-18 |
| 1093816910 | John Evans George | Dentist | 48842 Hayes Rd, Macomb, MI 48044-1954 | 2006-09-25 |
| 1396845418 | Gerald J. Garner | Dentist | 46401 Romeo Plank Rd, Suite 2, Macomb, MI 48044-3510 | 2006-09-25 |
| 1053321109 | Buffalo Prairie Dental Care of Macomb, Inc | Dentist | 200 S Mcarthur St, Macomb, IL 61455-2143 | 2006-08-09 |
| Find all providers in MACOMB | ||||
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| 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.