Provider Demographics
NPI:1538731997
Name:PATEL, KHUSHBUBEN CHIMANLAL (DDS)
Entity type:Individual
Prefix:
First Name:KHUSHBUBEN
Middle Name:CHIMANLAL
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KHUSHBU
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1403 W GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4705
Mailing Address - Country:US
Mailing Address - Phone:510-766-4230
Mailing Address - Fax:
Practice Address - Street 1:1403 W GLEN AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4705
Practice Address - Country:US
Practice Address - Phone:309-692-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist