Provider Demographics
NPI:1891912408
Name:BHARATKUMAR D. DESAI D.D.S.P.A.
Entity Type:Organization
Organization Name:BHARATKUMAR D. DESAI D.D.S.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BHARATKUMAR
Authorized Official - Middle Name:D
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-757-2500
Mailing Address - Street 1:1440 DUNN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4894
Mailing Address - Country:US
Mailing Address - Phone:904-757-2500
Mailing Address - Fax:
Practice Address - Street 1:1440 DUNN AVE STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4894
Practice Address - Country:US
Practice Address - Phone:904-757-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 0011247122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty