Provider Demographics
NPI:1083979744
Name:DESAI, KRUNAL (DDS)
Entity Type:Individual
Prefix:
First Name:KRUNAL
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 W BELT LINE RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3822
Mailing Address - Country:US
Mailing Address - Phone:732-599-8734
Mailing Address - Fax:
Practice Address - Street 1:921 W BELT LINE RD
Practice Address - Street 2:SUITE 117
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3822
Practice Address - Country:US
Practice Address - Phone:732-599-8734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX281651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice