Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 019.027969 | IL |
Y | 1223G0001X | General Practice | 019.027969 | IL |
Y | 213EG0000X | General Practice | 019.027969 | IL |
N | 1223P0300X | Periodontist | 019.027969 | IL |
N | 1223P0700X | Prosthodontist | 019.027969 | IL |
N | 1223X0400X | Orthodontists | 019.027969 | IL |
NPI | 1184850661 |
---|---|
Provider Name | Dr. Manisha V Desai |
First Address | Aurora, IL 60505 |
Second Address | Aurora, IL 60505-3429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2009 |
Last Update Date | 20/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1184850661 | (05) | IL |