Provider Demographics
NPI:1821057993
Name:FATLAND, WARREN SHERMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:SHERMAN
Last Name:FATLAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9957 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1554
Mailing Address - Country:US
Mailing Address - Phone:708-599-8400
Mailing Address - Fax:708-599-4171
Practice Address - Street 1:9957 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1554
Practice Address - Country:US
Practice Address - Phone:708-599-8400
Practice Address - Fax:708-599-4171
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190137331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice