Provider Demographics
NPI:1538575352
Name:DESAI, DEEP M (DDS)
Entity type:Individual
Prefix:DR
First Name:DEEP
Middle Name:M
Last Name:DESAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 BENCER CT
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-2304
Mailing Address - Country:US
Mailing Address - Phone:609-903-1500
Mailing Address - Fax:
Practice Address - Street 1:755 MEMORIAL PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2748
Practice Address - Country:US
Practice Address - Phone:609-903-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT112091223G0001X
PADS0399361223G0001X
NJ22DI025992001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice