Provider Demographics
NPI:1093060667
Name:DESAI, KAUSHAL CHANDRISH (DMD)
Entity Type:Individual
Prefix:
First Name:KAUSHAL
Middle Name:CHANDRISH
Last Name:DESAI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 COMMERCE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2714
Mailing Address - Country:US
Mailing Address - Phone:267-460-4254
Mailing Address - Fax:215-646-6166
Practice Address - Street 1:24 S 14TH ST
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1147
Practice Address - Country:US
Practice Address - Phone:215-536-3210
Practice Address - Fax:215-536-2972
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0392511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice