Provider Demographics
NPI:1073645214
Name:DESAI, JAGRUTI D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAGRUTI
Middle Name:D
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 1:1255 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-6618
Mailing Address - Country:US
Mailing Address - Phone:717-497-1097
Mailing Address - Fax:
Practice Address - Street 1:10 W CHOCOLATE AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1472
Practice Address - Country:US
Practice Address - Phone:717-534-1135
Practice Address - Fax:717-534-1449
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0362281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice