Provider Demographics
NPI:1114048071
Name:DESAI, SHEETAL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHEETAL
Middle Name:S
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 1:2403-05 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304
Mailing Address - Country:US
Mailing Address - Phone:201-332-1664
Mailing Address - Fax:201-332-8808
Practice Address - Street 1:2403-05 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY
Practice Address - State:NJ
Practice Address - Zip Code:07304
Practice Address - Country:US
Practice Address - Phone:201-332-1664
Practice Address - Fax:201-332-8808
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI02161600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist