Provider Demographics
NPI:1962631515
Name:DESAI, DEVANG HARSHAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEVANG
Middle Name:HARSHAD
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 1:3390 SOUTHERN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-6033
Mailing Address - Country:US
Mailing Address - Phone:803-447-6009
Mailing Address - Fax:
Practice Address - Street 1:2329 DEVINE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2431
Practice Address - Country:US
Practice Address - Phone:803-447-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-03
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9041122300000X
SC4644122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist