Provider Demographics
NPI:1366884819
Name:DESAI, VIRAJ (DMD)
Entity type:Individual
Prefix:DR
First Name:VIRAJ
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 W BRAKER LN
Mailing Address - Street 2:BLDG 1 SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-7853
Mailing Address - Country:US
Mailing Address - Phone:512-617-0110
Mailing Address - Fax:
Practice Address - Street 1:3310 W BRAKER LN
Practice Address - Street 2:BLDG 1 SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758
Practice Address - Country:US
Practice Address - Phone:512-617-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025351001223G0001X
TX295151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice