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General NPI Number Information
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NPI Number | 1922645308
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Entity Type | Organization
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Legal Business Name | RIDDHI J DESAI DMD PLLC
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Dates
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Enumeration Date | 12/04/2019
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 727 W MADISON ST APT 1208
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City | CHICAGO
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State | IL
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Zip | 60661-2409
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Country | US
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Telephone | 814-233-6460
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Fax |
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Provider Business Mailing Address
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Address Line | 727 W MADISON ST APT 1208
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City | CHICAGO
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State | IL
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Zip | 60661-2409
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Country | US
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Telephone | 814-233-6460
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | RIDDHI DESAI
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Credential | DMD
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Telephone | 814-233-6460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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