Provider Demographics
NPI:1093814469
Name:RAJENDRA DESAI DDS PA
Entity Type:Organization
Organization Name:RAJENDRA DESAI DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:410-997-7412
Mailing Address - Street 1:11055 LITTLE PATUXENT PKY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044
Mailing Address - Country:US
Mailing Address - Phone:410-997-7412
Mailing Address - Fax:410-997-0392
Practice Address - Street 1:11055 LITTLE PATUXENT PKY
Practice Address - Street 2:SUITE 207
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-997-7412
Practice Address - Fax:410-997-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD5785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty