Provider Demographics
NPI:1922216282
Name:DESAI, NIKHIL J (DDS)
Entity Type:Individual
Prefix:
First Name:NIKHIL
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 1:7501 ATLANTIC AVE
Mailing Address - Street 2:SUITE #C
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-6804
Mailing Address - Country:US
Mailing Address - Phone:323-771-1706
Mailing Address - Fax:323-771-1299
Practice Address - Street 1:7501 ATLANTIC AVE
Practice Address - Street 2:SUITE #C
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-6804
Practice Address - Country:US
Practice Address - Phone:323-771-1706
Practice Address - Fax:323-771-1299
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA409291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice