Provider Demographics
NPI:1578140794
Name:HRK DENTAL PLLC
Entity Type:Organization
Organization Name:HRK DENTAL PLLC
Other - Org Name:BLOOMINGDALE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FATLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:708-990-7869
Mailing Address - Street 1:7855 PINEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-9004
Mailing Address - Country:US
Mailing Address - Phone:708-990-7869
Mailing Address - Fax:
Practice Address - Street 1:183 S BLOOMINGDALE RD STE 102
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1454
Practice Address - Country:US
Practice Address - Phone:224-520-8665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental