Provider Demographics
NPI:1710430467
Name:PATEL, AENA YASH (DMD)
Entity Type:Individual
Prefix:
First Name:AENA
Middle Name:YASH
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MINER ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4718
Mailing Address - Country:US
Mailing Address - Phone:847-803-4580
Mailing Address - Fax:847-803-4857
Practice Address - Street 1:2100 MINER ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4718
Practice Address - Country:US
Practice Address - Phone:847-803-4580
Practice Address - Fax:847-803-4857
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist