Provider Demographics
NPI:1417089194
Name:PATEL, GAURAV A (DMD)
Entity Type:Individual
Prefix:DR
First Name:GAURAV
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:GAURAV
Other - Middle Name:A
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1000 GRAND CANYON PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60194-1705
Mailing Address - Country:US
Mailing Address - Phone:847-885-8780
Mailing Address - Fax:847-885-9818
Practice Address - Street 1:1000 GRAND CANYON PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60194-1705
Practice Address - Country:US
Practice Address - Phone:847-885-8780
Practice Address - Fax:847-885-9818
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01924608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist