Provider Demographics
NPI:1356461255
Name:THAKKAR, HIMANSHI C (DDS)
Entity Type:Individual
Prefix:DR
First Name:HIMANSHI
Middle Name:C
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 TRENT LN
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-8939
Mailing Address - Country:US
Mailing Address - Phone:815-219-0767
Mailing Address - Fax:815-544-3246
Practice Address - Street 1:121 S STATE ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-3628
Practice Address - Country:US
Practice Address - Phone:815-544-2626
Practice Address - Fax:815-544-3246
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist