Individual
KAVITA DESAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
8268 164TH ST, DENTAL CLINIC, JAMAICA, NY 11432-1104
(718) 883-3000
Mailing address
8268 164TH ST, DENTAL CLINIC, JAMAICA, NY 11432-1104
(718) 883-3000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
058773
NY
1223G0001X
General Practice Dentistry
058773
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058773
LICENSE
NY
Enumeration date
08/27/2015
Last updated
02/02/2021
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