Provider Demographics
NPI:1679848733
Name:DESAI, AMIT J (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:J
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 1:8224 JOSHUA CIR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4038
Mailing Address - Country:US
Mailing Address - Phone:714-308-3288
Mailing Address - Fax:
Practice Address - Street 1:8224 JOSHUA CIR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4038
Practice Address - Country:US
Practice Address - Phone:714-308-3288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist