Provider Demographics
NPI:1568744076
Name:THAKKAR, PURVI
Entity Type:Individual
Prefix:
First Name:PURVI
Middle Name:
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PURVI
Other - Middle Name:
Other - Last Name:BUDDHADEV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:614 KINNEAR CV
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5345
Mailing Address - Country:US
Mailing Address - Phone:630-823-1564
Mailing Address - Fax:
Practice Address - Street 1:614 KINNEAR CV
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60010-5345
Practice Address - Country:US
Practice Address - Phone:630-823-1564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028777122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist