Provider Demographics
NPI:1851725899
Name:PATEL, UTTAMKUMAR R (DDS)
Entity Type:Individual
Prefix:
First Name:UTTAMKUMAR
Middle Name:R
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 1:603 APPLE ST
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-1102
Mailing Address - Country:US
Mailing Address - Phone:848-565-4437
Mailing Address - Fax:815-625-7848
Practice Address - Street 1:4312 E LINCOLNWAY
Practice Address - Street 2:SUITE A
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-9793
Practice Address - Country:US
Practice Address - Phone:815-625-7002
Practice Address - Fax:815-625-7848
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist