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General NPI Number Information
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NPI Number | 1336492115
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Entity Type | Organization
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Legal Business Name | CRYSTAL R. PATEL, D.D.S, PC
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 33 N DEARBORN ST SUITE 2400
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City | CHICAGO
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State | IL
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Zip | 60602-3102
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Country | US
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Telephone | 630-935-0857
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Fax |
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Provider Business Mailing Address
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Address Line | 1377 N CLOVER CT
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City | ADDISON
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State | IL
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Zip | 60101-5728
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Country | US
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Telephone | 630-935-0857
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRYSTAL R PATEL
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Credential | DDS
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Telephone | 630-935-0857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019028316
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License Number State | IL
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