Provider Demographics
NPI:1104212059
Name:RAJIV N DESAI DDS INC
Entity Type:Organization
Organization Name:RAJIV N DESAI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:N
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-850-1211
Mailing Address - Street 1:1212 S BRISTOL ST STE 17C
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-3439
Mailing Address - Country:US
Mailing Address - Phone:714-850-1211
Mailing Address - Fax:714-850-9094
Practice Address - Street 1:1212 S BRISTOL ST STE 17C
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-3439
Practice Address - Country:US
Practice Address - Phone:714-850-1211
Practice Address - Fax:714-850-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA322941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty