Provider Demographics
NPI:1154440303
Name:DESAI, MADHAVI JANAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MADHAVI
Middle Name:JANAK
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 1:1800 N BRISTOL ST
Mailing Address - Street 2:#D
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3336
Mailing Address - Country:US
Mailing Address - Phone:714-541-4411
Mailing Address - Fax:714-541-4140
Practice Address - Street 1:1800 N BRISTOL ST
Practice Address - Street 2:#D
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3336
Practice Address - Country:US
Practice Address - Phone:714-541-4411
Practice Address - Fax:714-541-4140
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA378121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice