Provider Demographics
NPI:1427481266
Name:DESAI, ANSH YOGESH
Entity type:Individual
Prefix:
First Name:ANSH
Middle Name:YOGESH
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 1:468 ELM ST E
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-1827
Mailing Address - Country:US
Mailing Address - Phone:617-306-6733
Mailing Address - Fax:
Practice Address - Street 1:440 HANCOCK ST STE 205
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2442
Practice Address - Country:US
Practice Address - Phone:173-280-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN031981223G0001X
MADN1856380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice