Provider Demographics
NPI:1043226152
Name:DESAI, BAKULESH D (BDS)
Entity Type:Individual
Prefix:DR
First Name:BAKULESH
Middle Name:D
Last Name:DESAI
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 TATE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:NY
Mailing Address - Zip Code:10511-1142
Mailing Address - Country:US
Mailing Address - Phone:914-737-2519
Mailing Address - Fax:
Practice Address - Street 1:220 TATE AVE STE 1
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:NY
Practice Address - Zip Code:10511-1142
Practice Address - Country:US
Practice Address - Phone:914-737-2519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0334351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice