Provider Demographics
NPI:1912184664
Name:PATEL, KINNARI N (DDS)
Entity Type:Individual
Prefix:
First Name:KINNARI
Middle Name:N
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 N SHERIDAN RD
Mailing Address - Street 2:SUITE 434
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7528
Mailing Address - Country:US
Mailing Address - Phone:773-751-1704
Mailing Address - Fax:773-751-4175
Practice Address - Street 1:641 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-2032
Practice Address - Country:US
Practice Address - Phone:773-751-1704
Practice Address - Fax:773-751-4175
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190256131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBP8195376OtherDEA