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General NPI Number Information
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NPI Number | 1891059465
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Entity Type | Individual
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Provider Name | VIPASHA DESAI
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Gender | Female
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 258 S FRONTAGE RD
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City | NEW LONDON
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State | CT
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Zip | 06320-2641
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Country | US
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Telephone | 860-347-3485
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Fax |
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Provider Business Mailing Address
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Address Line | 33 HORIZON HILL RD
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City | NEWINGTON
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State | CT
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Zip | 06111-5115
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Country | US
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Telephone | 860-371-5885
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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 | 010778
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License Number State | CT
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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 | 010778
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License Number State | CT
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