Provider Demographics
NPI:1497905400
Name:DESAI, ANKUR JAYENDRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANKUR
Middle Name:JAYENDRA
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 1:217 MOUNT VERNON WAY
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-6421
Mailing Address - Country:US
Mailing Address - Phone:914-299-5219
Mailing Address - Fax:
Practice Address - Street 1:217 MOUNT VERNON WAY
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-6421
Practice Address - Country:US
Practice Address - Phone:914-299-5219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023878001223G0001X
TX372021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty