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General NPI Number Information
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NPI Number | 1891912408
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Entity Type | Organization
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Legal Business Name | BHARATKUMAR D. DESAI D.D.S.P.A.
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1440 DUNN AVE STE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32218-4894
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Country | US
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Telephone | 904-757-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 DUNN AVE STE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32218-4894
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Country | US
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Telephone | 904-757-2500
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MR. BHARATKUMAR D DESAI
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Credential | D.D.S.
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Telephone | 904-757-2500
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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 | DN 0011247
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License Number State | FL
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