Healthcare Provider Details

I. General information

NPI: 1942055124
Provider Name (Legal Business Name): VIDHI DESAI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 DOUGHERTY FERRY RD STE 200
SAINT LOUIS MO
63122-3356
US

IV. Provider business mailing address

26502 PARKWOOD DR
DENHAM SPRINGS LA
70726-6538
US

V. Phone/Fax

Practice location:
  • Phone: 314-394-1914
  • Fax:
Mailing address:
  • Phone: 225-347-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2026025333
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: