Healthcare Provider Details

I. General information

NPI: 1275372005
Provider Name (Legal Business Name): PRIYANSHI PRAVINKUMAR ZALAVADIYA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 ILLINOIS ROUTE 59
BARTLETT IL
60103
US

IV. Provider business mailing address

5876 E STATE ST
ROCKFORD IL
61108-2428
US

V. Phone/Fax

Practice location:
  • Phone: 331-241-6266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.035090
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: