Healthcare Provider Details

I. General information

NPI: 1750217097
Provider Name (Legal Business Name): JEEL DAFTARY DDSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 W NORTH AVE
CHICAGO IL
60647-5235
US

IV. Provider business mailing address

765 W ADAMS ST APT 2813
CHICAGO IL
60661-3517
US

V. Phone/Fax

Practice location:
  • Phone: 773-252-0033
  • Fax:
Mailing address:
  • Phone: 862-485-1270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037253
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: