Provider Demographics
NPI:1902896897
Name:DESAI, SINDOOR (BDS)
Entity Type:Individual
Prefix:DR
First Name:SINDOOR
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 COUNTY ROUTE 57
Mailing Address - Street 2:10
Mailing Address - City:PHOENIX
Mailing Address - State:NY
Mailing Address - Zip Code:13135-3300
Mailing Address - Country:US
Mailing Address - Phone:315-695-2128
Mailing Address - Fax:315-695-5678
Practice Address - Street 1:219 COUNTY ROUTE 57
Practice Address - Street 2:10
Practice Address - City:PHOENIX
Practice Address - State:NY
Practice Address - Zip Code:13135-3300
Practice Address - Country:US
Practice Address - Phone:315-695-2128
Practice Address - Fax:315-695-5678
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0340101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice