Shivani Chetan Desai, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019029949 Issued in IL

Practice address

1904 Wakefield LN
Bloomington, IL 61704-9196

Phone

(309) 287-4952

NPI assigned

Jul 28, 2014

Last updated

Jul 28, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406505600000",
    "number": "1184032666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1904 WAKEFIELD LN",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617049196",
            "telephone_number": "309-287-4952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1904 WAKEFIELD LN",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617049196",
            "telephone_number": "309-287-4952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESAI",
        "first_name": "SHIVANI",
        "middle_name": "CHETAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-28",
        "last_updated": "2014-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019029949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Professionals of Illinois, P.C. (Bloomington Smile Center)
• John Scott Denton, M.D.
• Julia Deredowski
• Dermatology and Mohs Surgery Institute, LTD.
• Dermatology and Skin Cancer Center
• Debra Descarpentrie, LPC
• Hatem Desoky, M.D.
• Hannah Deterding
• Angie Detwiler, CNM
• Elizabeth Ann Deutsch, OT

• Dentist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.