Healthcare Provider Details

I. General information

NPI: 1083983423
Provider Name (Legal Business Name): VIREN V PATEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E WASHINGTON ST 1921
CHICAGO IL
60602-1708
US

IV. Provider business mailing address

25 E WASHINGTON ST 1921
CHICAGO IL
60602-1708
US

V. Phone/Fax

Practice location:
  • Phone: 312-782-8862
  • Fax: 312-376-1440
Mailing address:
  • Phone: 312-782-8862
  • Fax: 312-376-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19025500
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: