MEDICARE: DR. ANDREW SARPOTDAR D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D008698	AZ

General Provider Information

NPI Number	:	1508203365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW SARPOTDAR D.D.S., M.S.

Provider Business Mailing Address
First Line	:	4595 FLORES AVE
Second Line	:
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928-1340
Country	:	US
Telephone Number	:	858-663-4694
Fax Number	:

Provider Business Practice Location Address
First Line	:	1619 N DYSART RD STE 105
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85392-1200
Country	:	US
Telephone Number	:	623-935-6278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	06/03/2013

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