Provider Demographics
NPI:1063277531
Name:PATEL, HARVI SUBHASH (DDS)
Entity type:Individual
Prefix:
First Name:HARVI
Middle Name:SUBHASH
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 1:2710 PONTIAC LN APT 1924
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9007
Mailing Address - Country:US
Mailing Address - Phone:314-319-1674
Mailing Address - Fax:
Practice Address - Street 1:2254 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2411
Practice Address - Country:US
Practice Address - Phone:708-656-2222
Practice Address - Fax:708-652-3990
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190353111223G0001X
IL019-0353111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice