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General NPI Number Information
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NPI Number | 1992090443
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Entity Type | Organization
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Legal Business Name | DR. SIVAN PATEL D.M.D. P.C.
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 1533 ELLINWOOD AVE
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City | DES PLAINES
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State | IL
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Zip | 60016-4553
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Country | US
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Telephone | 847-297-0808
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Fax |
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Provider Business Mailing Address
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Address Line | 1545 SHORT TER
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City | DES PLAINES
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State | IL
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Zip | 60018-5558
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Country | US
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Telephone | 847-532-8990
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SIVAN PATEL
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Credential | D.M.D.
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Telephone | 847-532-8990
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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 | 019028147
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License Number State | IL
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