Provider Demographics
NPI:1730373671
Name:PATARI, KIRAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:
Last Name:PATARI
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 1:77 E IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-2930
Mailing Address - Country:US
Mailing Address - Phone:630-837-0310
Mailing Address - Fax:630-830-3301
Practice Address - Street 1:77 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-2930
Practice Address - Country:US
Practice Address - Phone:630-837-0310
Practice Address - Fax:630-830-3301
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190231551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice