Provider Demographics
NPI:1154415073
Name:CHETNA K. DESAI, D.D.S, P.C.
Entity type:Organization
Organization Name:CHETNA K. DESAI, D.D.S, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHETNA
Authorized Official - Middle Name:KARTIK
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-480-9111
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21041-0450
Mailing Address - Country:US
Mailing Address - Phone:410-480-9111
Mailing Address - Fax:410-480-9133
Practice Address - Street 1:3290 N. RIDGE ROAD
Practice Address - Street 2:SUITE #180
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:410-480-9111
Practice Address - Fax:410-480-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD008749100Medicaid