Healthcare Provider Details

I. General information

NPI: 1881580165
Provider Name (Legal Business Name): HITARTH PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 MANCHESTER RD
SAINT LOUIS MO
63119-1333
US

IV. Provider business mailing address

219 LILLIAN PL
BARTLETT IL
60103-2315
US

V. Phone/Fax

Practice location:
  • Phone: 331-308-3341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2025021095
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.036240
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: