Provider Demographics
NPI:1932643111
Name:DESAI DENTAL SPA, PC
Entity Type:Organization
Organization Name:DESAI DENTAL SPA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:GALE-MARIE
Authorized Official - Last Name:KOPSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-848-1126
Mailing Address - Street 1:28535 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE # 400
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2940
Mailing Address - Country:US
Mailing Address - Phone:248-848-1126
Mailing Address - Fax:
Practice Address - Street 1:28535 ORCHARD LAKE RD
Practice Address - Street 2:SUITE # 400
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2940
Practice Address - Country:US
Practice Address - Phone:248-848-1126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty