Healthcare Provider Details

I. General information

NPI: 1487098257
Provider Name (Legal Business Name): JAIMINI A. DESAI,D.M.D.,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 QUAKER LN
WARWICK RI
02886-0111
US

IV. Provider business mailing address

80 QUAKER LN
WARWICK RI
02886-0111
US

V. Phone/Fax

Practice location:
  • Phone: 401-821-6500
  • Fax:
Mailing address:
  • Phone: 401-821-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN02515
License Number StateRI

VIII. Authorized Official

Name: DR. JAIMINI ARVIN DESAI
Title or Position: PRESIDENT
Credential: D.M.D
Phone: 401-821-6500