Provider Demographics
NPI:1841380300
Name:DESAI, SHARADCHANDRA GHANASHYAM (BDS)
Entity Type:Individual
Prefix:DR
First Name:SHARADCHANDRA
Middle Name:GHANASHYAM
Last Name:DESAI
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7060 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-4661
Mailing Address - Country:US
Mailing Address - Phone:716-216-4341
Mailing Address - Fax:
Practice Address - Street 1:3099 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-1919
Practice Address - Country:US
Practice Address - Phone:716-668-2998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0320761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice