Provider Demographics
NPI:1265503080
Name:PATEL, RAUNAK (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAUNAK
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3203
Mailing Address - Country:US
Mailing Address - Phone:312-201-1610
Mailing Address - Fax:
Practice Address - Street 1:2111 S STATE ROUTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-4622
Practice Address - Country:US
Practice Address - Phone:815-609-1110
Practice Address - Fax:815-609-0575
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0264491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice