Provider Demographics
NPI:1568478428
Name:DESAI, MAMTA VINAYAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAMTA
Middle Name:VINAYAK
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 1:5145 STEVENS CREEK BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6600
Mailing Address - Country:US
Mailing Address - Phone:408-246-1111
Mailing Address - Fax:408-246-1114
Practice Address - Street 1:5145 STEVENS CREEK BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-6600
Practice Address - Country:US
Practice Address - Phone:408-246-1111
Practice Address - Fax:408-246-1114
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice