Provider Demographics
NPI:1346231610
Name:PATEL, AMRITLAL J (DDS)
Entity Type:Individual
Prefix:
First Name:AMRITLAL
Middle Name:J
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 1:357 S ROSELLE RD
Mailing Address - Street 2:SUBURBAN PLAZA
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-1602
Mailing Address - Country:US
Mailing Address - Phone:847-985-9323
Mailing Address - Fax:847-985-9324
Practice Address - Street 1:357 S ROSELLE RD
Practice Address - Street 2:SUBURBAN PLAZA
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-1602
Practice Address - Country:US
Practice Address - Phone:847-985-9323
Practice Address - Fax:847-985-9324
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19015510122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003258Medicaid