Provider Demographics
NPI:1619150455
Name:MISTRY, DHIREN VALJIBHAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:DHIREN
Middle Name:VALJIBHAI
Last Name:MISTRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2474 E DEMPSTER ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5314
Mailing Address - Country:US
Mailing Address - Phone:847-803-4580
Mailing Address - Fax:
Practice Address - Street 1:2474 E DEMPSTER ST
Practice Address - Street 2:SUITE 206
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-5314
Practice Address - Country:US
Practice Address - Phone:847-803-4580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-16
Last Update Date:2007-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice