Organization
PERFORMACE DENTAL CARE IL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN FATLAND FATLAND (DENTIST)
(815) 464-8850
Entity
Organization
Contact information
Practice address
7230 191ST ST, TINLEY PARK, IL 60487-9378
(815) 464-8850
Mailing address
7230 191ST ST, TINLEY PARK, IL 60487-9378
(815) 464-8850
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19025070
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01902570
—
IL
Enumeration date
04/22/2014
Last updated
04/22/2014
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