Provider Demographics
NPI:1750586061
Name:PATEL, HETALKUMAR (DDS)
Entity type:Individual
Prefix:
First Name:HETALKUMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-5037
Mailing Address - Country:US
Mailing Address - Phone:630-890-6102
Mailing Address - Fax:
Practice Address - Street 1:837 WESTMORE MEYERS RD
Practice Address - Street 2:SUITE B29-30
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3724
Practice Address - Country:US
Practice Address - Phone:630-620-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190274031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice