Individual
DR. KEHINDE JOHN FASANYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6215 E STATE ST, ROCKFORD, IL 61108-2514
(920) 838-1649
Mailing address
430 W ERIE ST STE 200, CHICAGO, IL 60654-6920
(920) 838-1649
(312) 944-9499
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.028443
IL
Other
Enumeration date
08/16/2010
Last updated
04/23/2021
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