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General NPI Number Information
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NPI Number | 1578631362
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Entity Type | Organization
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Legal Business Name | PRAVIN R DESAI DDS INC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 4127 EAST GAGE AVENUE
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City | BELL
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State | CA
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Zip | 90201-1128
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Country | US
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Telephone | 323-773-2931
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Fax | 323-773-2933
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Provider Business Mailing Address
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Address Line | 4127 EAST GAGE AVENUE
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City | BELL
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State | CA
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Zip | 90201-1128
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Country | US
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Telephone | 323-773-2931
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Fax | 323-773-2933
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Authorized Official
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Title or Position | PRESIDENT DENTIST OWNER
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Name | PRAVIN RATILAL DESAI
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Credential | DDS
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Telephone | 323-773-2931
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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 | 28537
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License Number State | CA
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