LIFETIME DENTAL CARE OF ILLINOIS, PC (NPI# 1770705923) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770705923 |
| Entity Type | Organization |
| Organization Name | LIFETIME DENTAL CARE OF ILLINOIS, PC |
| Other Organization Name | DENTAL GROUP OF BOURBONNAIS |
| Practice Address |
761 Main Street Nw Suite C Bourbonnais IL 60914 |
| Practice Telephone | 8159333377 |
| Practice Fax Number | 8159336530 |
| Mailing Telephone | 8159333377 |
| Mailing Fax Number | 8159336530 |
| 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 |
|---|---|
| Dental Group of Bourbonnais | 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 |
| 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 |
| Street Address |
761 MAIN STREET NW SUITE C |
| City | BOURBONNAIS |
| State | IL |
| Zip Code | 60914 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648023 | Jacob Daniel Ledesma | Physical Therapist | 588 William R Latham Senior Dr Ste 5, Bourbonnais, IL 60914 | 2020-10-30 |
| 1467069823 | Alicia Nicole Kendra | Nurse Practitioner | Upliftedcare, 482 Main St. Nw, Bourbonnais, IL 60914 | 2020-09-29 |
| 1043860877 | Victor Manuel Vazquez Cervantes | Pharmacist | 2080 No, Il-50, Bourbonnais, IL 60914 | 2019-09-13 |
| 1740843267 | Panoptic Physical Therapy LLC | Physical Medicine & Rehabilitation | 1511 N. Convent St Suite 1000, Bourbonnais, IL 60914 | 2019-04-19 |
| 1770074577 | Colin P Koerner | Physical Therapist | 215 N Convent St Ste 6, Bourbonnais, IL 60914 | 2018-05-29 |
| 1306337340 | Megan Hoskins | Behavior Technician | 3187 N 2420 W Rd., Bourbonnais, IL 60914 | 2018-05-25 |
| 1932600459 | Thomas H George Dds PC | Clinic/Center | 14 Briarcliff Professional Center, Bourbonnais, IL 60914 | 2018-02-21 |
| 1780193904 | Kathleen M Saindon II | Speech-Language Pathologist | 1021 Deer Trail, Bourbonnais, IL 60914 | 2017-09-20 |
| 1457870206 | Janet Mary Notton | Speech-Language Pathologist | 920 W Margaret Lane, Bourbonnais, IL 60914 | 2017-09-13 |
| 1134646375 | Sagar Batish | Student in an Organized Health Care Education/Training Program | 1096 Country Lane, Bourbonnais, IL 60914 | 2017-08-28 |
| Find all providers in zip 60914 | ||||
| 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 |
|---|---|---|---|---|
| 1649763475 | Madalyn E Snyder | Dentist | 482 Brown Blvd, Bourbonnais, IL 60914-2324 | 2018-06-06 |
| 1861786071 | Sarbjit Kaur Thind | Dentist | 1501 N State Route 50, Bourbonnais, IL 60914 | 2011-06-06 |
| 1295906584 | Bradley Dental, LLC | Dentist | 2034 N State Route 50, Bourbonnais, IL 60914-4410 | 2008-03-14 |
| 1760513535 | James Kent Guebert | Dentist | 498 Brown Blvd, Bourbonnais, IL 60914-2324 | 2007-03-07 |
| 1649313016 | Thomas Edward Brezinski | Dentist | 765 Plum Creek Dr, Bourbonnais, IL 60914-2101 | 2007-02-15 |
| 1831243146 | Joseph A Wertz | Dentist | 588 William R Latham Sr Dr Ste 2, Bourbonnais, IL 60914-2340 | 2007-01-23 |
| 1851483663 | James R Martell | Dentist | 590 William R Latham Sr Dr, Bourbonnais, IL 60914-2320 | 2006-09-29 |
| 1750494142 | Scott P. Fogel Dds PC | Dentist | 1521 N Convent St, Suite 600, Bourbonnais, IL 60914-1468 | 2006-08-17 |
| 1578557997 | John A Vallone | Dentist | 35 Briarcliff Prof Ctr, Bourbonnais, IL 60914-1775 | 2005-08-31 |
| 1013575356 | Leah Katherine Thomas | Dentist | 1501 N State Route 50, Bourbonnais, IL 60914-4429 | 2019-06-02 |
| Find all providers in BOURBONNAIS | ||||
| City | BOURBONNAIS |
| Zip Code | 60914 |
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.