Organization
IVORY DENTAL
Active
Parent organization
IVORY DENTAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
IVORY DENTAL
Authorized official
DR. SHEFALI PATEL (OWNER)
(815) 577-0900
Entity
Organization
Contact information
Practice address
12624 S ROUTE 59, PLAINFIELD, IL 60585-5448
(815) 577-0900
(815) 577-6331
Mailing address
12624 S ROUTE 59, PLAINFIELD, IL 60585-5448
(815) 577-0900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019025824
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043387707
TYPE I
IL
Enumeration date
06/28/2017
Last updated
07/21/2022
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