Active NPI
Dhara Patel
- Dentist
- Melrose Park, IL
National Provider Identifier
1407309545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019030821
- Practice address
- 1812 Broadway St
Melrose Park, IL 60160-2039 - Phone
- (312) 771-5380
- NPI assigned
- Jul 25, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019030821 | IL | Primary |
Addresses
Primary practice location
1812 Broadway St
Melrose Park, IL 60160-2039
Mailing address
930 Omaha Dr
Norcross, GA 30093-4964
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019030821 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469404800000",
"number": "1407309545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "930 OMAHA DR",
"city": "NORCROSS",
"state": "GA",
"postal_code": "300934964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1812 BROADWAY ST",
"city": "MELROSE PARK",
"state": "IL",
"postal_code": "601602039",
"telephone_number": "312-771-5380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATEL",
"first_name": "DHARA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-25",
"last_updated": "2016-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019030821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melrose Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.