Provider Demographics
NPI:1891819397
Name:SANDIP DESAI DDS INC.
Entity Type:Organization
Organization Name:SANDIP DESAI DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-697-8888
Mailing Address - Street 1:23962 ALESSANDRO BLVD
Mailing Address - Street 2:SUITE # R
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-8817
Mailing Address - Country:US
Mailing Address - Phone:951-697-8888
Mailing Address - Fax:951-697-8886
Practice Address - Street 1:23962 ALESSANDRO BLVD
Practice Address - Street 2:SUITE # R
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-8817
Practice Address - Country:US
Practice Address - Phone:951-697-8888
Practice Address - Fax:951-697-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43139122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty