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NPI Code Detail

MEDICARE: NISHANT PATEL D.D.S

MEDICARE: NISHANT PATEL D.D.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry021002461IL
2122300000XDentist019.028279IL

General Provider Information

NPI Number : 1407103658
Entity Type Code : Individual
Provider Name (Legal Business Name) : NISHANT PATEL D.D.S
Provider Business Mailing Address
First Line : 965 PIMLICO LN
Second Line :
City : BARTLETT
State : IL
Zip : 60103-2073
Country : US
Telephone Number : 630-776-1432
Fax Number :
Provider Business Practice Location Address
First Line : 4401 W LAWRENCE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-2510
Country : US
Telephone Number : 773-725-6086
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2012
Last Update Date : 08/09/2012

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