MEDICARE: MRS. GEETA H DESAI DDS

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	035871	CA

General Provider Information

NPI Number	:	1770743106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GEETA H DESAI DDS

Provider Business Mailing Address
First Line	:	4910 A PASEO PADRE PKWY
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94555
Country	:	US
Telephone Number	:	510-790-3886
Fax Number	:	510-790-3132

Provider Business Practice Location Address
First Line	:	4910 PASEO PADRE PKWY
Second Line	:	A
City	:	FREMONT
State	:	CA
Zip	:	94555-3412
Country	:	US
Telephone Number	:	510-790-3886
Fax Number	:	510-790-3132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/10/2008

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