Individual
KRISHNA H DESAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7584 E STATE ROUTE 69, PRESCOTT VALLEY, AZ 86314-2278
(510) 736-9890
Mailing address
172 BLACK MOUNTAIN CIR, FREMONT, CA 94536-6530
(510) 736-9890
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
016.0134081
VT
1223G0001X
General Practice Dentistry
Primary
D011685
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
$$$$$$$$$
—
CA
Enumeration date
02/15/2022
Last updated
03/30/2023
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