Provider Demographics
NPI:1205983830
Name:DESAR, JYOTI VINOD (DDS)
Entity type:Individual
Prefix:DR
First Name:JYOTI
Middle Name:VINOD
Last Name:DESAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 INDIANA AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4297
Mailing Address - Country:US
Mailing Address - Phone:951-276-2222
Mailing Address - Fax:951-276-2222
Practice Address - Street 1:6700 INDIANA AVE STE 115
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4297
Practice Address - Country:US
Practice Address - Phone:951-276-2222
Practice Address - Fax:951-276-2222
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist