Provider Demographics
NPI:1174657274
Name:PATEL, PRANAV YOGESH (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRANAV
Middle Name:YOGESH
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 S BARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-5345
Mailing Address - Country:US
Mailing Address - Phone:847-534-1100
Mailing Address - Fax:847-534-0011
Practice Address - Street 1:319 S BARRINGTON RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-5345
Practice Address - Country:US
Practice Address - Phone:847-534-1100
Practice Address - Fax:847-534-0011
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026243122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9175756Medicaid