Provider Demographics
NPI:1477723393
Name:J.R. PATEL DMD PC
Entity Type:Organization
Organization Name:J.R. PATEL DMD PC
Other - Org Name:SMILES ON RANDALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JABAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-426-9430
Mailing Address - Street 1:2158 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-3345
Mailing Address - Country:US
Mailing Address - Phone:847-426-9430
Mailing Address - Fax:847-426-9439
Practice Address - Street 1:2158 RANDALL RD
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-3345
Practice Address - Country:US
Practice Address - Phone:847-426-9430
Practice Address - Fax:847-426-9439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190269381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty