Healthcare Provider Details

I. General information

NPI: 1750813614
Provider Name (Legal Business Name): REENA PATEL D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 MILWAUKEE RD UNIT B
BELOIT WI
53511-3976
US

IV. Provider business mailing address

9857 W SAINT STEPHANS DR
FRANKLIN WI
53132-7907
US

V. Phone/Fax

Practice location:
  • Phone: 608-813-8891
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019031309
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1001558-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: