| NPI | 1942377908 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN L FATLAND Pres Of Corp 815-464-8850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019025070) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2015-08-28 |