5 Star Family Dental
Organization Active NPI General Practice Dentistry · South Holland, IL
NPI 1013462175 · NPPES record last updated Feb 3, 2017
Key facts
- NPI
- 1013462175
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019025070 (IL)
- Legal business name
- 5 STAR FAMILY DENTAL
- Practice address
- 615 E 162ND St
South Holland, IL 60473-2329 - Phone
- (708) 331-1900
- NPI assigned
- Aug 18, 2016
- Organization subpart
- No
Authorized official
- Name
- Dr. Kevin Lloyd Fatland, DMD
- Title
- Dentist / Owner
- Phone
- (708) 990-7869
Practitioners 2
-
Patrick Michael Gorman, D.D.S.
-
Gurleen Rajput, DDS
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | 019025070 | IL | Yes |
Addresses
Primary practice location
615 E 162ND St
South Holland, IL 60473-2329
Mailing address
615 E 162ND St
South Holland, IL 60473-2329
Phone (708) 331-1900
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- Tamar Adams
- Tracey C Adams
All providers in South Holland, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.