Healthcare Provider Details

I. General information

NPI: 1376463919
Provider Name (Legal Business Name): RESTFUL REGION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 JOLIET ST
DYER IN
46311-1926
US

IV. Provider business mailing address

1123 JOLIET ST
DYER IN
46311-1926
US

V. Phone/Fax

Practice location:
  • Phone: 219-225-2294
  • Fax: 866-228-8954
Mailing address:
  • Phone: 219-225-2294
  • Fax: 866-228-8954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: STACEY TATRO
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 708-228-8056