Provider Demographics
NPI:1629474580
Name:DESAI, NIRANJAN (DDS)
Entity Type:Individual
Prefix:
First Name:NIRANJAN
Middle Name:
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 1:2537 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-7031
Mailing Address - Country:US
Mailing Address - Phone:570-226-8800
Mailing Address - Fax:570-226-3511
Practice Address - Street 1:2537 ROUTE 6
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-7031
Practice Address - Country:US
Practice Address - Phone:570-226-8800
Practice Address - Fax:570-226-3511
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist