Provider Demographics
NPI:1932317781
Name:SUSHILCHANDRA G. DESAI DDS, PC
Entity Type:Organization
Organization Name:SUSHILCHANDRA G. DESAI DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSHILCHANDRA
Authorized Official - Middle Name:GHELABHAI
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-473-7444
Mailing Address - Street 1:6032 LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-4230
Mailing Address - Country:US
Mailing Address - Phone:215-473-7444
Mailing Address - Fax:215-473-4183
Practice Address - Street 1:6032 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-4230
Practice Address - Country:US
Practice Address - Phone:215-473-7444
Practice Address - Fax:215-473-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020600L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008635320002Medicaid
PADS020600LOtherSTATE LICENSE