Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 019.029287 | IL |
NPI | 1174937833 |
---|---|
Provider Name | Dhara Patel |
First Address | Bartlett, IL 60103-7880 |
Second Address | Bartlett, IL 60103-7880 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2014 |
Last Update Date | 19/06/2014 |