Healthcare Provider Details

I. General information

NPI: 1144582370
Provider Name (Legal Business Name): AMITKUMAR PRAVINKUMAR PATEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AMIT PRAVINBHAI PATEL

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 OAKBROOK CENTER MALL
OAK BROOK IL
60523-1810
US

IV. Provider business mailing address

372 WINDSONG CIR
GLENDALE HEIGHTS IL
60139-4500
US

V. Phone/Fax

Practice location:
  • Phone: 201-920-6233
  • Fax:
Mailing address:
  • Phone: 201-920-6233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019029128
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: