Provider Demographics
NPI:1265816995
Name:PATEL, PARAJ SURYAKANT (DMD)
Entity Type:Individual
Prefix:DR
First Name:PARAJ
Middle Name:SURYAKANT
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 1:413 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3233
Mailing Address - Country:US
Mailing Address - Phone:201-303-8996
Mailing Address - Fax:
Practice Address - Street 1:604 CENTER PKWY STE B
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1690
Practice Address - Country:US
Practice Address - Phone:201-303-8996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190302701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
319019491OtherLICENSED DENTIST CONTROLLED SUBSTANCE
IL019030270OtherLICENSE NUMBER