Provider Demographics
NPI:1699975409
Name:PATEL, SIMA (DDS)
Entity type:Individual
Prefix:DR
First Name:SIMA
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 1:28956 W STATE ROUTE 120
Mailing Address - Street 2:
Mailing Address - City:LAKEMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60051-2215
Mailing Address - Country:US
Mailing Address - Phone:815-363-8888
Mailing Address - Fax:815-363-8890
Practice Address - Street 1:28956 W STATE ROUTE 120
Practice Address - Street 2:
Practice Address - City:LAKEMOOR
Practice Address - State:IL
Practice Address - Zip Code:60051-2215
Practice Address - Country:US
Practice Address - Phone:815-363-8888
Practice Address - Fax:815-363-8890
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist