Healthcare Provider Details

I. General information

NPI: 1770129926
Provider Name (Legal Business Name): HIRAL DESAI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 E 1ST ST
TUSTIN CA
92780-3418
US

IV. Provider business mailing address

604 E 1ST ST
TUSTIN CA
92780-3418
US

V. Phone/Fax

Practice location:
  • Phone: 145-059-4627
  • Fax: 714-505-2559
Mailing address:
  • Phone: 714-505-9462
  • Fax: 714-505-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number104212
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number104212
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number104212
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number104212
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number104212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: