Provider Demographics
NPI:1396000956
Name:PATEL, SHIVAM S (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIVAM
Middle Name:S
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 1:681 E HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-7711
Mailing Address - Country:US
Mailing Address - Phone:224-558-4897
Mailing Address - Fax:
Practice Address - Street 1:545 S YORK RD STE 200
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-3000
Practice Address - Country:US
Practice Address - Phone:630-766-0115
Practice Address - Fax:630-766-1164
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0290811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice