Provider Demographics
NPI:1073242939
Name:DESAI, HARDIK RAJENDRAKUMAR
Entity Type:Individual
Prefix:
First Name:HARDIK
Middle Name:RAJENDRAKUMAR
Last Name:DESAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 PARSIPPANY BLVD APT 18
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1817
Mailing Address - Country:US
Mailing Address - Phone:973-452-1662
Mailing Address - Fax:
Practice Address - Street 1:134 EVERGREEN PL STE 101
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2015
Practice Address - Country:US
Practice Address - Phone:973-968-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI029045001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice