Provider Demographics
NPI:1629417274
Name:PATEL, DHAVAL MAHESH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DHAVAL
Middle Name:MAHESH
Last Name:PATEL
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 1:8853 N WASHINGTON ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3609
Mailing Address - Country:US
Mailing Address - Phone:847-965-2383
Mailing Address - Fax:
Practice Address - Street 1:939 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-7138
Practice Address - Country:US
Practice Address - Phone:312-642-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0294061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice