Provider Demographics
NPI:1427334515
Name:DESAI, PARIN
Entity type:Individual
Prefix:
First Name:PARIN
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 TRADE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-8190
Mailing Address - Country:US
Mailing Address - Phone:630-851-7878
Mailing Address - Fax:
Practice Address - Street 1:95 TRADE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8190
Practice Address - Country:US
Practice Address - Phone:630-851-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9203210OtherDENTAQUEST