Healthcare Provider Details

I. General information

NPI: 1649346594
Provider Name (Legal Business Name): HITESH K PATEL DDS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 MACOM DR STE 107
NAPERVILLE IL
60564-3205
US

IV. Provider business mailing address

1309 MACOM DR STE 107
NAPERVILLE IL
60564-3205
US

V. Phone/Fax

Practice location:
  • Phone: 630-305-7914
  • Fax: 630-305-7575
Mailing address:
  • Phone: 630-305-7914
  • Fax: 630-305-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019019205
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019019205
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. HITESH K PATEL
Title or Position: OWNER
Credential: DDS
Phone: 630-305-7914