Provider Demographics
NPI:1811207871
Name:PATEL, DEEPAN PRAVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEEPAN
Middle Name:PRAVIN
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N KINGSBURY ST
Mailing Address - Street 2:UNIT 4007
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8766
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 N KINGSBURY ST
Practice Address - Street 2:APT. 4007
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-8766
Practice Address - Country:US
Practice Address - Phone:616-443-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190285101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice