Provider Demographics
NPI:1609235118
Name:PATEL, CHANDNI K (DDS)
Entity Type:Individual
Prefix:
First Name:CHANDNI
Middle Name:K
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 E MONROE ST
Mailing Address - Street 2:UNIT #4802
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-2758
Mailing Address - Country:US
Mailing Address - Phone:661-364-5050
Mailing Address - Fax:
Practice Address - Street 1:4830 N PULASKI RD STE 108
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2847
Practice Address - Country:US
Practice Address - Phone:661-364-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0307821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice