MEDICARE: LIFETIME DENTAL CAREOF INDIANA, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1891917282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME DENTAL CAREOF INDIANA, PC

Provider Business Mailing Address
First Line	:	1605 NORTH IRONWOOD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46635
Country	:	US
Telephone Number	:	574-271-9693
Fax Number	:	574-271-9719

Provider Business Practice Location Address
First Line	:	1605 NORTH IRONWOOD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46635
Country	:	US
Telephone Number	:	574-271-9693
Fax Number	:	574-271-9719

Authorized Official
Title or Position	:	INS COOD
Name	:	AMY KROEGER
Credential	:
Telephone Number	:	217-540-5100

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1730035577 — TAMIA SYMONE ROBINSON
Practice Location Address:

17551 GENERATIONS DR
SOUTH BEND, IN
46635-1589

Practice Phone: 574-400-2169
Practice Fax:

1427051341 — DR. JOHN GLENN MATHIS M.D.
Practice Location Address:

17501 GENERATIONS DR
SOUTH BEND, IN
46635-1589

Practice Phone: 574-234-0049
Practice Fax: 574-251-2861

1437152394 — DR. LORI L. CHECKLEY M.D.
Practice Location Address:

17231 WILSHIRE DR
SOUTH BEND, IN
46635-2068

Practice Phone: 269-445-7295
Practice Fax:

1427051796 — SOUTH BEND IN ENDOSCOPY ASC LLC
Practice Location Address:

53830 GENERATIONS DR
SOUTH BEND, IN
46635-1557

Practice Phone: 574-271-0893
Practice Fax: 574-271-4362

1649272725 — DR. MICHAEL ALAN MANBECK M.D.
Practice Location Address:

17501 GENERATIONS DR
SOUTH BEND, IN
46635-1589

Practice Phone: 574-234-0049
Practice Fax: 574-251-2861

1497759765 — DR. OLIVER D GILLIAM M.D.
Practice Location Address:

17501 GENERATIONS DR
SOUTH BEND, IN
46635-1589

Practice Phone: 574-234-0049
Practice Fax: 574-251-2861

1063416931 — DONALD W SMITH MD
Practice Location Address:

6301 UNIVERSITY COMMONS
SOUTH BEND, IN
46635-1571

Practice Phone: 574-234-4016
Practice Fax: 574-239-4607

Directions to “LIFETIME DENTAL CAREOF INDIANA, PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.