Provider Demographics
NPI:1396132205
Name:DESAI, NEETI (DMD)
Entity type:Individual
Prefix:DR
First Name:NEETI
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 2ND AVE APT 335
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4443
Mailing Address - Country:US
Mailing Address - Phone:407-925-1222
Mailing Address - Fax:
Practice Address - Street 1:315 BOSTON RD
Practice Address - Street 2:
Practice Address - City:NORTH BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01862-2635
Practice Address - Country:US
Practice Address - Phone:978-262-0023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414808122300000X
PADS042591122300000X
MADN1859242122300000X
MD15885122300000X
NJ22DI02590800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist