Individual
JITENDRAKUMAR PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
802 N 9TH ST, SPRINGFIELD, IL 62702-6309
(630) 248-2526
Mailing address
1636 TORONTO RD APT 7, SPRINGFIELD, IL 62712-3716
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019029119
IL
Other
Enumeration date
07/13/2012
Last updated
07/13/2012
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