Provider Demographics
NPI:1861908444
Name:PATEL, PRANAV VINOD
Entity type:Individual
Prefix:
First Name:PRANAV
Middle Name:VINOD
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 S WASHINGTON ST STE 210
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7964
Mailing Address - Country:US
Mailing Address - Phone:630-961-3810
Mailing Address - Fax:630-961-2466
Practice Address - Street 1:1112 S WASHINGTON ST STE 210
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7964
Practice Address - Country:US
Practice Address - Phone:630-961-3810
Practice Address - Fax:630-961-2466
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL210018981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics