Healthcare Provider Details

I. General information

NPI: 1790666568
Provider Name (Legal Business Name): AURUM DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5923 GREEN BAY RD
KENOSHA WI
53144-3737
US

IV. Provider business mailing address

5923 GREEN BAY RD
KENOSHA WI
53144-3737
US

V. Phone/Fax

Practice location:
  • Phone: 262-266-1777
  • Fax: 262-266-1711
Mailing address:
  • Phone: 262-266-1777
  • Fax: 262-266-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PRATIK PATEL
Title or Position: OWNER
Credential: MD
Phone: 214-606-3029