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Organization
PERFORMANCE DENTAL CARE PC
Active
Organization
PERFORMANCE DENTAL CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN L FATLAND DMD (PRES OF CORP)
(815) 464-8850
Entity
Organization
Contact information
Practice address
7230 191ST ST, TINLEY PARK, IL 60487-9378
(815) 464-8850
(708) 777-4797
Mailing address
7230 191ST ST, TINLEY PARK, IL 60487-9378
(815) 464-8850
(708) 777-4797
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019025070
IL
Other
Enumeration date
11/28/2006
Last updated
08/28/2015
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