Individual
DR. KEVIN LLOYD FATLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
19509 GOVERNOR'S HIGHWAY, FLOSSMOOR, IL 60422-2097
(708) 647-7509
(708) 647-7918
Mailing address
19509 GOVERNOR'S HIGHWAY, FLOSSMOOR, IL 60422-2097
(708) 647-7509
(708) 647-7918
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12010455A
IN
1223G0001X
General Practice Dentistry
Primary
19025070
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019025070
—
IL
05
—
200361700A
—
IN
Enumeration date
07/17/2006
Last updated
12/30/2008
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