Provider Demographics
NPI:1942363957
Name:DESAI, SUNIL B (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:B
Last Name:DESAI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PETERSON CT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3950
Mailing Address - Country:US
Mailing Address - Phone:973-773-7340
Mailing Address - Fax:
Practice Address - Street 1:4 PETERSON CT
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3950
Practice Address - Country:US
Practice Address - Phone:973-773-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ21025122300000X
NY048637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist