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General NPI Number Information
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NPI Number | 1497324420
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Entity Type | Individual
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Provider Name | PHORUM DESAI
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Gender | Female
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 1919 7TH AVE S
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City | BIRMINGHAM
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State | AL
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Zip | 35233-2005
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Country | US
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Telephone | 832-314-1819
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 3RD AVE S APT 501
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City | BIRMINGHAM
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State | AL
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Zip | 35233-2151
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Country | US
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Telephone | 832-314-1819
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | A-28029
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License Number State | ZZ
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