MEDICARE: DESAI DENTISTRY PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1932850930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESAI DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	15900 LA CANTERA PKWY STE 20250
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-2512
Country	:	US
Telephone Number	:	210-877-0000
Fax Number	:	210-877-0010

Provider Business Practice Location Address
First Line	:	15900 LA CANTERA PKWY STE 20250
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-2512
Country	:	US
Telephone Number	:	210-877-0000
Fax Number	:	210-877-0010

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	VIVIAN NGUYEN
Credential	:
Telephone Number	:	210-877-0000

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	01/12/2022

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