Healthcare Provider Details

I. General information

NPI: 1841697638
Provider Name (Legal Business Name): GANESH DENTAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E NORTH AVENUE
CAROL STREAM IL
60188-2128
US

IV. Provider business mailing address

590 E NORTH AVE
CAROL STREAM IL
60188
US

V. Phone/Fax

Practice location:
  • Phone: 203-895-3594
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MANISHA DESAI
Title or Position: OWNER/DOCTOR
Credential: D.M.D
Phone: 203-362-9987