Provider Demographics
NPI:1720480338
Name:DESAI, MEDHA PATEL (DDS)
Entity type:Individual
Prefix:
First Name:MEDHA
Middle Name:PATEL
Last Name:DESAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MEDHA
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2095 JACKSON ST APT 103
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-2806
Mailing Address - Country:US
Mailing Address - Phone:805-215-2968
Mailing Address - Fax:
Practice Address - Street 1:2380 MONUMENT BLVD STE F
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3972
Practice Address - Country:US
Practice Address - Phone:925-363-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist