NPIMap

Organization Active NPI

Performance Dental Care PC

  • General Practice Dentistry
  • Tinley Park, IL
National Provider Identifier
1942377908
Registry record updated Aug 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019025070 Issued in IL
Legal business name
PERFORMANCE DENTAL CARE PC
Practice address
7230 191St St
Tinley Park, IL 60487-9378
Phone
(815) 464-8850
Fax
(708) 777-4797
NPI assigned
Nov 28, 2006
Last updated
Aug 28, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2015

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

Authorized official

Name
Dr. Kevin L Fatland, DMD
Title
Pres of Corp
Phone
(815) 464-8850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019025070 IL Primary

Addresses

Primary practice location

7230 191St St
Tinley Park, IL 60487-9378

Mailing address

7230 191St St
Tinley Park, IL 60487-9378
Phone (815) 464-8850

National Provider Directory

National Provider Directory
Tax ID family
Performace Dental Care Il PC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440720000000",
    "number": "1942377908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7230 191ST ST",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604879378",
            "telephone_number": "815-464-8850",
            "fax_number": "708-777-4797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7230 191ST ST",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604879378",
            "telephone_number": "815-464-8850",
            "fax_number": "708-777-4797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE DENTAL CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2015-08-28",
        "status": "A",
        "authorized_official_last_name": "FATLAND",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRES OF CORP",
        "authorized_official_telephone_number": "815-464-8850",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tinley Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2015; 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.