Individual
MS. EKTA DESAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
11711 W BURLEIGH ST, WAUWATOSA, WI 53222-3108
(414) 771-2345
Mailing address
11711 W BURLEIGH ST, WAUWATOSA, WI 53222-3108
(414) 771-2345
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1001318-15
WI
1223G0001X
General Practice Dentistry
Primary
1001318
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
WI
Other
Enumeration date
04/18/2016
Last updated
10/28/2020
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