Provider Demographics
NPI:1336281872
Name:DESAI, RAJIV NATHUBHAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:NATHUBHAI
Last Name:DESAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13100 BIGELOW ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7375
Mailing Address - Country:US
Mailing Address - Phone:562-860-5577
Mailing Address - Fax:
Practice Address - Street 1:1212 S BRISTOL ST
Practice Address - Street 2:#17C
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-3476
Practice Address - Country:US
Practice Address - Phone:714-850-1211
Practice Address - Fax:714-850-9094
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA322941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice