Healthcare Provider Details

I. General information

NPI: 1639693237
Provider Name (Legal Business Name): HARSHIL V PATEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 RIDGEVIEW DR
MCHENRY IL
60050-7054
US

IV. Provider business mailing address

1540 DEMPSTER ST APT 310
MT PROSPECT IL
60056-4943
US

V. Phone/Fax

Practice location:
  • Phone: 815-847-9292
  • Fax:
Mailing address:
  • Phone: 224-345-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019031282
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: