Healthcare Provider Details

I. General information

NPI: 1871411025
Provider Name (Legal Business Name): ADITI JATIN PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2964 COMMERCE DR
JOHNSBURG IL
60051-5409
US

IV. Provider business mailing address

1095 ELLSWORTH DR
GRAYSLAKE IL
60030-3364
US

V. Phone/Fax

Practice location:
  • Phone: 815-363-0103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037276
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: