Provider Demographics
NPI:1417269820
Name:DESATNIK, DOUGLAS E (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:E
Last Name:DESATNIK
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 1:22901 MILLCREEK BLVD
Mailing Address - Street 2:SUITE #140
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5728
Mailing Address - Country:US
Mailing Address - Phone:216-464-9800
Mailing Address - Fax:216-464-9833
Practice Address - Street 1:22901 MILLCREEK BLVD
Practice Address - Street 2:SUITE #140
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5728
Practice Address - Country:US
Practice Address - Phone:216-464-9800
Practice Address - Fax:216-464-9833
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist