Healthcare Provider Details

I. General information

NPI: 1750642609
Provider Name (Legal Business Name): HBP DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E ROOSEVELT RD SUITE 112
WEST CHICAGO IL
60185-3918
US

IV. Provider business mailing address

440 E ROOSEVELT RD SUITE 112
WEST CHICAGO IL
60185-3918
US

V. Phone/Fax

Practice location:
  • Phone: 847-909-0703
  • Fax:
Mailing address:
  • Phone: 847-909-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019027323
License Number StateIL

VIII. Authorized Official

Name: DR. HETAL B PATEL
Title or Position: PRESIDENT
Credential: DDS
Phone: 847-909-0703