Provider Demographics
NPI:1407264716
Name:PATEL, JIGNESH (DDS)
Entity Type:Individual
Prefix:
First Name:JIGNESH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JIGNESHKUMAR
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2401 W US HIGHWAY 20 STE 103
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-8819
Mailing Address - Country:US
Mailing Address - Phone:847-462-4330
Mailing Address - Fax:847-513-9457
Practice Address - Street 1:2401 W US HIGHWAY 20 STE 103
Practice Address - Street 2:
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140-8819
Practice Address - Country:US
Practice Address - Phone:847-462-4330
Practice Address - Fax:847-513-9457
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190299771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice