Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019.032220 | IL |
NPI | 1003468851 |
---|---|
Provider Name | Soha D Patel |
First Address | Aurora, IL 60506-5134 |
Second Address | Aurora, IL 60506-5134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2019 |
Last Update Date | 20/01/2021 |