Provider Demographics
NPI:1659668119
Name:PHALGUNI PATEL DDS PC
Entity Type:Organization
Organization Name:PHALGUNI PATEL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHALGUNI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-477-7078
Mailing Address - Street 1:856 W NELSON ST
Mailing Address - Street 2:APT #803
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5152
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:856 W NELSON ST
Practice Address - Street 2:APT #803
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5152
Practice Address - Country:US
Practice Address - Phone:773-477-7078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.026270122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty