Provider Demographics
NPI:1922520469
Name:PATEL, VRUSHTI PRAHARSH (DDS, BDS)
Entity Type:Individual
Prefix:DR
First Name:VRUSHTI
Middle Name:PRAHARSH
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS, BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S STATE ST UNIT 3203
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2243
Mailing Address - Country:US
Mailing Address - Phone:609-907-9115
Mailing Address - Fax:
Practice Address - Street 1:5622 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4001
Practice Address - Country:US
Practice Address - Phone:847-983-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-15
Last Update Date:2017-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL319.020622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist