MEDICARE: DESAI DENTAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1326767682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESAI DENTAL PC

Provider Business Mailing Address
First Line	:	4913 RUFE SNOW DR STE 104
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-7856
Country	:	US
Telephone Number	:	817-656-2945
Fax Number	:

Provider Business Practice Location Address
First Line	:	4913 RUFE SNOW DR STE 104
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-7856
Country	:	US
Telephone Number	:	817-656-2945
Fax Number	:	817-656-1695

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SONAL DESAI
Credential	:	DDS
Telephone Number	:	817-773-0886

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	08/23/2022

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