Provider Demographics
NPI:1790003440
Name:DESAI, BHAVIK S (DMD, PHD)
Entity type:Individual
Prefix:
First Name:BHAVIK
Middle Name:S
Last Name:DESAI
Suffix:
Gender:M
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6722 S TUMBLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8725
Mailing Address - Country:US
Mailing Address - Phone:443-255-8743
Mailing Address - Fax:
Practice Address - Street 1:8405 W FOREST HOME AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-3407
Practice Address - Country:US
Practice Address - Phone:443-255-8743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413562122300000X
GADN0155441223S0112X
MADN1857012125Q00000X
WI1002220-151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No125Q00000XDental ProvidersDentistOral Medicine