Healthcare Provider Details

I. General information

NPI: 1790003440
Provider Name (Legal Business Name): BHAVIK S. DESAI DMD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8405 W FOREST HOME AVE
GREENFIELD WI
53228-3407
US

IV. Provider business mailing address

6722 S TUMBLE CREEK DR
FRANKLIN WI
53132-8725
US

V. Phone/Fax

Practice location:
  • Phone: 443-255-8743
  • Fax:
Mailing address:
  • Phone: 443-255-8743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401413562
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN015544
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code125Q00000X
TaxonomyOral Medicine Dentistry
License NumberDN1857012
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1002220-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: