| Performace Dental Care Il Pc | |
|
7230 191st St Tinley Park IL 60487-9378 | |
| (815) 464-8850 | |
| Not Available |
| Full Name | Performace Dental Care Il Pc |
|---|---|
| Speciality | Dentist |
| Location | 7230 191st St, Tinley Park, Illinois |
| Authorized Official Name and Position | Kevin Fatland Fatland (DENTIST) |
| Authorized Official Contact | 8154648850 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Performace Dental Care Il Pc 7230 191st St Tinley Park IL 60487-9378 Ph: (815) 464-8850 | Performace Dental Care Il Pc 7230 191st St Tinley Park IL 60487-9378 Ph: (815) 464-8850 |
| NPI Number | 1447670054 |
|---|---|
| Provider Enumeration Date | 04/22/2014 |
| Last Update Date | 04/22/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447670054 | NPI | - | NPPES |
| 01902570 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 19025070 (Illinois) | Primary |
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