Provider Demographics
NPI:1316119308
Name:DESAI, SUSHILCHANDRA GHELABHAI (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSHILCHANDRA
Middle Name:GHELABHAI
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 1:6032 LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-4230
Mailing Address - Country:US
Mailing Address - Phone:215-473-7444
Mailing Address - Fax:215-473-4183
Practice Address - Street 1:6032 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-4230
Practice Address - Country:US
Practice Address - Phone:215-473-7444
Practice Address - Fax:215-473-4183
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020600L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008635320002Medicaid
PADS020600LOtherSTATE LICENSE NO.