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General NPI Number Information
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NPI Number | 1750073979
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Entity Type | Individual
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Provider Name | MANIL DESAI DDS
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Gender | Male
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 2006 10TH ST
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City | FLORESVILLE
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State | TX
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Zip | 78114-2770
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Country | US
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Telephone | 830-393-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 22 CORNWALL RD
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City | NORWALK
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State | CT
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Zip | 06850-1834
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Country | US
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Telephone | 203-434-1221
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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 | 39895
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License Number State | TX
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