Provider Demographics
NPI:1407988173
Name:DESAI, USHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:USHA
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 1:23 REYNOLDS AVE
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-3323
Mailing Address - Country:US
Mailing Address - Phone:973-887-3000
Mailing Address - Fax:
Practice Address - Street 1:23 REYNOLDS AVE
Practice Address - Street 2:LIFE OK DENTAL LLC
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-3323
Practice Address - Country:US
Practice Address - Phone:973-887-3000
Practice Address - Fax:973-599-1009
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102146800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1407988173Medicare UPIN