Provider Demographics
NPI:1457413650
Name:PATEL, JITEN B
Entity type:Individual
Prefix:
First Name:JITEN
Middle Name:B
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JITEN
Other - Middle Name:B
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS MS
Mailing Address - Street 1:522 CHESTNUT STREET
Mailing Address - Street 2:SUITE GA
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521
Mailing Address - Country:US
Mailing Address - Phone:630-655-3636
Mailing Address - Fax:630-655-3767
Practice Address - Street 1:522 CHESTNUT STREET
Practice Address - Street 2:SUITE GA
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:630-655-3636
Practice Address - Fax:630-655-3767
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics