Provider Demographics
NPI:1770770182
Name:HATLAND, RAYMOND GILBERT (DDS)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:GILBERT
Last Name:HATLAND
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 1:6453 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-4000
Mailing Address - Country:US
Mailing Address - Phone:773-338-4440
Mailing Address - Fax:773-338-4442
Practice Address - Street 1:6453 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-4000
Practice Address - Country:US
Practice Address - Phone:773-338-4440
Practice Address - Fax:773-338-4442
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-29
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019013050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist