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General NPI Number Information
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NPI Number | 1790003440
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Entity Type | Individual
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Provider Name | BHAVIK S. DESAI DMD, PHD
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Gender | Male
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Dates
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Enumeration Date | 05/05/2010
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 8405 W FOREST HOME AVE
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City | GREENFIELD
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State | WI
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Zip | 53228-3407
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Country | US
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Telephone | 443-255-8743
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Fax |
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Provider Business Mailing Address
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Address Line | 6722 S TUMBLE CREEK DR
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City | FRANKLIN
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State | WI
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Zip | 53132-8725
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Country | US
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Telephone | 443-255-8743
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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 | 0401413562
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN015544
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 125Q00000X
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Taxonomy Name | Oral Medicine Dentistry
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License Number | DN1857012
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 1002220-15
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License Number State | WI
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