Individual
MR. KEVIN M TATLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.D.
Contact information
Practice address
473 SW 12TH ST, ONTARIO, OR 97914-3201
(541) 889-3282
(541) 881-0653
Mailing address
473 SW 12TH ST, ONTARIO, OR 97914-3201
(541) 889-3282
(541) 881-0653
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DT-DO-854277
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125851
—
OR
Enumeration date
08/31/2006
Last updated
07/09/2007
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