| NPI | 1013462175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN LLOYD FATLAND Dentist / Owner 708-990-7869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019025070) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2017-02-03 |