Provider Demographics
NPI:1376066860
Name:PATEL, SHILAM SHIRISH (DMD)
Entity Type:Individual
Prefix:
First Name:SHILAM
Middle Name:SHIRISH
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OAK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1129
Mailing Address - Country:US
Mailing Address - Phone:630-892-6515
Mailing Address - Fax:
Practice Address - Street 1:111 OAK STREET
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542
Practice Address - Country:US
Practice Address - Phone:630-892-6515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.031190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist