Kankakee Dental PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

KANKAKEE DENTAL PLLC

Practice address

200 E Court St Ste 504
Kankakee, IL 60901-3847

Phone

(815) 932-3613

NPI assigned

Jul 12, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin Fatland, DMDNPI 1245258318

Title

Member

Phone

(708) 990-7869

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin Lloyd Fatland, D.M.D.

  • General Practice Dentistry
  • Flossmoor, IL
  • NPI 1245258318
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626048000000",
    "number": "1780256503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E COURT ST STE 504",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013847",
            "telephone_number": "815-932-3613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E COURT ST STE 504",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013847",
            "telephone_number": "815-932-3613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANKAKEE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-12",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A",
        "authorized_official_last_name": "FATLAND",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "708-990-7869",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kankakee Area Special Education Coop
• Kankakee Area Special Education Cooperative
• Kankakee Autism Care Therapy
• Kankakee County Health Departmetn
• Kankakee County Health Dept
• Kankakee Emergency Physicians LLC
• Kankakee Family Medicine
• Kankakee Il CVS LLC
• Kankakee Pain Surgical Suite, LLC
• Kankakee Radiology Associates, S.C.

• Dental Clinic/Center in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.