Provider Demographics
NPI:1710922752
Name:THAKKAR, DEVANG TULSIDAS (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DEVANG
Middle Name:TULSIDAS
Last Name:THAKKAR
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4271 LINDEN TREE LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1224
Mailing Address - Country:US
Mailing Address - Phone:847-998-0207
Mailing Address - Fax:
Practice Address - Street 1:18130 HALSTED ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2507
Practice Address - Country:US
Practice Address - Phone:708-799-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL210020971223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics