Provider Demographics
NPI:1598159162
Name:SGPATEL, D.D.S., P.C.
Entity Type:Organization
Organization Name:SGPATEL, D.D.S., P.C.
Other - Org Name:KISHWAUKEE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEJAL
Authorized Official - Middle Name:GIRISH
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-445-4772
Mailing Address - Street 1:1740 MEDITERRANEAN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3191
Mailing Address - Country:US
Mailing Address - Phone:815-895-0777
Mailing Address - Fax:815-895-0776
Practice Address - Street 1:1740 MEDITERRANEAN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3191
Practice Address - Country:US
Practice Address - Phone:815-895-0777
Practice Address - Fax:815-895-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190276201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty