Provider Demographics
NPI:1497209407
Name:RAJUL PATEL WESTLOOP PC
Entity Type:Organization
Organization Name:RAJUL PATEL WESTLOOP PC
Other - Org Name:PURE DENTAL SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RAJUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-988-0025
Mailing Address - Street 1:1222 W MADISON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2044
Mailing Address - Country:US
Mailing Address - Phone:312-988-0025
Mailing Address - Fax:312-757-1898
Practice Address - Street 1:1222 W MADISON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2044
Practice Address - Country:US
Practice Address - Phone:312-988-0025
Practice Address - Fax:312-757-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027791122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty