Provider Demographics
NPI:1336109099
Name:DESAI, SHILPA S (BDS)
Entity Type:Individual
Prefix:DR
First Name:SHILPA
Middle Name:S
Last Name:DESAI
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 MAJESTIC OAK DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-4083
Mailing Address - Country:US
Mailing Address - Phone:407-464-0400
Mailing Address - Fax:
Practice Address - Street 1:2908 N ORANGE AVE
Practice Address - Street 2:SUITE202
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:407-898-3471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN142821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice