Provider Demographics
NPI:1669101341
Name:PATEL, SONAL PRAMOD (DMD)
Entity type:Individual
Prefix:DR
First Name:SONAL
Middle Name:PRAMOD
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-8769
Mailing Address - Country:US
Mailing Address - Phone:217-553-4717
Mailing Address - Fax:
Practice Address - Street 1:737 N MICHIGAN AVE STE 910
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6651
Practice Address - Country:US
Practice Address - Phone:312-266-9487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190336881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice