Aditya Desai, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DD4374 Issued in NM

Practice address

4017 N Prince St
Clovis, NM 88101-9705

Phone

(888) 988-4066

Fax

(847) 496-4850

NPI assigned

Aug 4, 2015

Last updated

Jan 14, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Familia Dentalclovis LLC

  dba Familia Dental

  • General Practice Dentistry
  • Clovis, NM
  • NPI 1841583291
  NPD (past)
• Familia Dental Mkemidtown LLC

  • General Practice Dentistry
  • Milwaukee, WI
  • NPI 1982086955
  NPD (past)
• Familia Dental Mkemitchell LLC

  • Dental Clinic/Center
  • Milwaukee, WI
  • NPI 1609259266

  General Practice

  NPD (past)

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

{
    "created_epoch": "1438646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1740666536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 E ALGONQUIN RD",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734144",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-4850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4017 N PRINCE ST",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881019705",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-4850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "206 NE 7th Ave",
            "address_purpose": "LOCATION",
            "city": "Amarillo",
            "state": "TX",
            "postal_code": "791075214",
            "country_code": "US",
            "telephone_number": "888-988-4066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESAI",
        "first_name": "ADITYA",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-08-04",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD4374",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "36819",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tia M Delloiacono, MS, OTR/L
• Jonathan Wesley Delong, PHARM.D.
• Alison Deluca, M.D.
• Abigail H Dennis
• Erin Derossitt
• Kim G Devou, NP
• Diane C Dewitt, O.D.
• Bianca Lyzette Diaz
• Silvia Diaz, BMS
• Jennifer Nichole Dickerson, RN

• Dentist in Clovis, NM
• Providers in Clovis, NM by specialty
• Dentist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.