Provider Demographics
NPI:1023302551
Name:DESAI, NEHA SAURABH (DDS)
Entity type:Individual
Prefix:DR
First Name:NEHA
Middle Name:SAURABH
Last Name:DESAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NEHA
Other - Middle Name:ANILBHAI
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS
Mailing Address - Street 1:31187 MORLOCK ST
Mailing Address - Street 2:APT 518
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1668
Mailing Address - Country:US
Mailing Address - Phone:248-736-9498
Mailing Address - Fax:248-987-4272
Practice Address - Street 1:31187 MORLOCK ST
Practice Address - Street 2:APT 518
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1668
Practice Address - Country:US
Practice Address - Phone:248-736-9498
Practice Address - Fax:248-987-4272
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist