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General NPI Number Information
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NPI Number | 1578140794
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Entity Type | Organization
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Legal Business Name | HRK DENTAL PLLC
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 183 S BLOOMINGDALE RD STE 102
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1454
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Country | US
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Telephone | 224-520-8665
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Fax |
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Provider Business Mailing Address
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Address Line | 7855 PINEVIEW LN
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City | FRANKFORT
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State | IL
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Zip | 60423-9004
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Country | US
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Telephone | 708-990-7869
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. KEVIN FATLAND
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Credential | DMD
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Telephone | 708-990-7869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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