MEDICARE: DR. NISHA KAUR SANDHU BDS BS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	60989146	WA

General Provider Information

NPI Number	:	1548758113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NISHA KAUR SANDHU BDS BS

Provider Business Mailing Address
First Line	:	2224 KAMBER RD
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98007-6229
Country	:	US
Telephone Number	:	425-829-3542
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 BROADWAY E AVENUE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-5023
Country	:	US
Telephone Number	:	206-829-4333
Fax Number	:

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

Provider Enumeration Date	:	04/28/2018
Last Update Date	:	08/08/2022

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