Healthcare Provider Details

I. General information

NPI: 1093663718
Provider Name (Legal Business Name): DEBORAH PATEQI DDS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 W FULLERTON AVE UNIT C106
CHICAGO IL
60707-3439
US

IV. Provider business mailing address

1421 GRACEDALE DR
ROCHESTER HILLS MI
48309-2261
US

V. Phone/Fax

Practice location:
  • Phone: 773-385-6700
  • Fax:
Mailing address:
  • Phone: 248-550-6156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: