Provider Demographics
NPI:1922645308
Name:RIDDHI J DESAI DMD PLLC
Entity Type:Organization
Organization Name:RIDDHI J DESAI DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:RIDDHI
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-233-6460
Mailing Address - Street 1:727 W MADISON ST APT 1208
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2409
Mailing Address - Country:US
Mailing Address - Phone:814-233-6460
Mailing Address - Fax:
Practice Address - Street 1:727 W MADISON ST APT 1208
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2409
Practice Address - Country:US
Practice Address - Phone:814-233-6460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty