Provider Demographics
NPI:1932850930
Name:DESAI DENTISTRY PLLC
Entity Type:Organization
Organization Name:DESAI DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-877-0000
Mailing Address - Street 1:15900 LA CANTERA PKWY STE 20250
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-2512
Mailing Address - Country:US
Mailing Address - Phone:210-877-0000
Mailing Address - Fax:210-877-0010
Practice Address - Street 1:15900 LA CANTERA PKWY STE 20250
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-2512
Practice Address - Country:US
Practice Address - Phone:210-877-0000
Practice Address - Fax:210-877-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental