Healthcare Provider Details

I. General information

NPI: 1205207859
Provider Name (Legal Business Name): USP DENTAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 TOWNHALL DR
ROMEOVILLE IL
60446-1338
US

IV. Provider business mailing address

620 TOWNHALL DR
ROMEOVILLE IL
60446-1338
US

V. Phone/Fax

Practice location:
  • Phone: 815-886-0875
  • Fax: 815-886-0075
Mailing address:
  • Phone: 815-886-0875
  • Fax: 815-886-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019025420
License Number StateIL

VIII. Authorized Official

Name: DR. UMANG PATEL
Title or Position: DOCTOR
Credential: D.O.
Phone: 815-886-0875