Provider Demographics
NPI:1255417911
Name:PATEL, KAMLESH MAHENDRA (BDS)
Entity type:Individual
Prefix:DR
First Name:KAMLESH
Middle Name:MAHENDRA
Last Name:PATEL
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-327-9500
Mailing Address - Fax:773-327-3080
Practice Address - Street 1:1628 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-327-9500
Practice Address - Fax:773-327-3080
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210020361223S0112X
IL0190249661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U95005Medicare UPIN