Provider Demographics
NPI:1952757775
Name:PATEL, TRUSHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRUSHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 S BLOOMINGDALE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1466
Mailing Address - Country:US
Mailing Address - Phone:630-980-9200
Mailing Address - Fax:
Practice Address - Street 1:183 S BLOOMINGDALE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1466
Practice Address - Country:US
Practice Address - Phone:630-980-9200
Practice Address - Fax:630-980-6841
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-4104827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist