Provider Demographics
NPI:1740456292
Name:DESAI, MADHVI KANTABEN (BDS)
Entity type:Individual
Prefix:
First Name:MADHVI
Middle Name:KANTABEN
Last Name:DESAI
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:MADHVI
Other - Middle Name:BIPIN
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS
Mailing Address - Street 1:40 N PARK VICTORIA DR
Mailing Address - Street 2:#D
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035
Mailing Address - Country:US
Mailing Address - Phone:408-263-0371
Mailing Address - Fax:408-263-0241
Practice Address - Street 1:40 N PARK VICTORIA DR
Practice Address - Street 2:#D
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035
Practice Address - Country:US
Practice Address - Phone:408-263-0371
Practice Address - Fax:408-263-0241
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist