Provider Demographics
NPI:1225446834
Name:DESAI, KRUTIBEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRUTIBEN
Middle Name:
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 1:15 RAWLS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-6033
Mailing Address - Country:US
Mailing Address - Phone:919-639-0264
Mailing Address - Fax:
Practice Address - Street 1:15 RAWLS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-6033
Practice Address - Country:US
Practice Address - Phone:919-639-0264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist