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General NPI Number Information
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NPI Number | 1700288164
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Entity Type | Organization
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Legal Business Name | GEENA R. PATEL DDS PC
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Dates
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Enumeration Date | 09/17/2014
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 20 TOWER CT SUITE D
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City | GURNEE
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State | IL
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Zip | 60031-5711
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Country | US
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Telephone | 224-399-9535
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Fax |
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Provider Business Mailing Address
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Address Line | 20 TOWER CT SUITE D
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City | GURNEE
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State | IL
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Zip | 60031-5711
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Country | US
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Telephone | 224-399-9535
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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. GEENA R PATEL
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Credential | D.D.S.
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Telephone | 224-399-9535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019028494
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License Number State | IL
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