Provider Demographics
NPI:1689952616
Name:DESAI, UTSAV (DMD)
Entity Type:Individual
Prefix:
First Name:UTSAV
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-2506
Mailing Address - Country:US
Mailing Address - Phone:860-595-3903
Mailing Address - Fax:860-726-4181
Practice Address - Street 1:368 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-2506
Practice Address - Country:US
Practice Address - Phone:860-595-3903
Practice Address - Fax:860-726-4181
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA388401223G0001X
MI29010205461223G0001X
CT111671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice