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General NPI Number Information
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NPI Number | 1184850661
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Entity Type | Individual
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Provider Name | MANISHA V DESAI DMD
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Gender | Female
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 12/20/2016
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Provider Practice Location Address
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Address Line | 5 N ROOT ST SUITE #105
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City | AURORA
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State | IL
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Zip | 60505-3429
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Country | US
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Telephone | 630-800-1137
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Fax | 630-800-1672
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Provider Business Mailing Address
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Address Line | 5 N. ROOT ST. SUITE #105
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City | AURORA
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State | IL
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Zip | 60505
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Country | US
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Telephone | 630-800-1137
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Fax | 630-800-1672
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.027969
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 019.027969
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019.027969
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 019.027969
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 019.027969
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License Number State | IL
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