Organization
5 STAR FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN LLOYD FATLAND DMD (DENTIST / OWNER)
(708) 990-7869
Entity
Organization
Contact information
Practice address
615 E 162ND ST, SOUTH HOLLAND, IL 60473-2329
(708) 331-1900
Mailing address
615 E 162ND ST, SOUTH HOLLAND, IL 60473-2329
(708) 331-1900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019025070
IL
Other
Enumeration date
08/18/2016
Last updated
02/03/2017
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