1821555186 NPI number — SANDHU DMD, INC

Table of content: (NPI 1821555186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821555186 NPI number — SANDHU DMD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDHU DMD, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821555186
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12619 ELK COVE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91739-8859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-996-5793
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6886 INDIANA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92506-4218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-446-5793
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2019

Additional Information

Authorized Official

Authorized Official Last Name:
SANDHU
Authorized Official First Name:
KABIR
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DENTIST-OWNER
Authorized Official Telephone Number:
909-996-5793

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1184052482 . This is a "DENTIST" identifier . This identifiers is of the category "OTHER".




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