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General NPI Number Information
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NPI Number | 1790430189
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Entity Type | Individual
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Provider Name | KRISHNA H DESAI
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Gender | Female
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 7584 E STATE ROUTE 69
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-2278
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Country | US
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Telephone | 510-736-9890
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Fax |
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Provider Business Mailing Address
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Address Line | 172 BLACK MOUNTAIN CIR
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City | FREMONT
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State | CA
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Zip | 94536-6530
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Country | US
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Telephone | 510-736-9890
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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 | 016.0134081
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D011685
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License Number State | AZ
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