Healthcare Provider Details

I. General information

NPI: 1588585939
Provider Name (Legal Business Name): PARTHKUMAR CHAMPAKBHAI PATEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 W ELM ST
OLNEY IL
62450-1620
US

IV. Provider business mailing address

1525 MERRIMAC LN N
HANOVER PARK IL
60133-6213
US

V. Phone/Fax

Practice location:
  • Phone: 224-384-0485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037317
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: