Provider Demographics
NPI:1144582370
Name:PATEL, AMITKUMAR PRAVINKUMAR (DMD)
Entity Type:Individual
Prefix:
First Name:AMITKUMAR
Middle Name:PRAVINKUMAR
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:AMIT
Other - Middle Name:PRAVINBHAI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:372 WINDSONG CIR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-4500
Mailing Address - Country:US
Mailing Address - Phone:201-920-6233
Mailing Address - Fax:
Practice Address - Street 1:2 OAKBROOK CENTER MALL
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1810
Practice Address - Country:US
Practice Address - Phone:201-920-6233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL019029128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program