Provider Demographics
NPI:1013034891
Name:DESAI, CHETNA KARTIK (DDS)
Entity Type:Individual
Prefix:
First Name:CHETNA
Middle Name:KARTIK
Last Name:DESAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 N RIDGE RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3655
Mailing Address - Country:US
Mailing Address - Phone:410-480-9111
Mailing Address - Fax:410-480-9133
Practice Address - Street 1:3290 N RIDGE RD
Practice Address - Street 2:SUITE 180
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3363
Practice Address - Country:US
Practice Address - Phone:410-480-9111
Practice Address - Fax:410-480-9133
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2013-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD122041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD008749100Medicaid