Provider Demographics
NPI:1770129926
Name:DESAI, HIRAL (DDS)
Entity type:Individual
Prefix:DR
First Name:HIRAL
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3418
Mailing Address - Country:US
Mailing Address - Phone:145-059-4627
Mailing Address - Fax:714-505-2559
Practice Address - Street 1:604 E 1ST ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3418
Practice Address - Country:US
Practice Address - Phone:145-059-4627
Practice Address - Fax:714-505-2559
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1042121223G0001X, 122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice