MEDICARE: VALAY DESAI D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30928	TX

General Provider Information

NPI Number	:	1356721401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALAY DESAI D.D.S.

Provider Business Mailing Address
First Line	:	5602 PRESIDIO PKWY
Second Line	:	APT 2329
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5602 PRESIDIO PKWY
Second Line	:	APT 2329
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3084
Country	:	US
Telephone Number	:	913-213-9712
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	06/04/2015

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