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General NPI Number Information
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NPI Number | 1649686775
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Entity Type | Organization
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Legal Business Name | MADHAVI J DESAI,DDS, INC.
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 1800 N BRISTOL ST #D
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City | SANTA ANA
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State | CA
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Zip | 92706-3336
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Country | US
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Telephone | 714-541-4411
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Fax | 714-541-4140
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Provider Business Mailing Address
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Address Line | 1800 N BRISTOL ST #D
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City | SANTA ANA
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State | CA
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Zip | 92706-3336
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Country | US
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Telephone | 714-541-4411
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Fax | 714-541-4140
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Authorized Official
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Title or Position | SECRETARY
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Name | JANAK DESAI
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Credential |
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Telephone | 714-541-4411
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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 | 37812
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License Number State | CA
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