Healthcare Provider Details

I. General information

NPI: 1922955640
Provider Name (Legal Business Name): SANDIP KAUR DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 STILLWATER DR STE B
PRESCOTT AZ
86305-7105
US

IV. Provider business mailing address

3140 STILLWATER DR STE B
PRESCOTT AZ
86305-7105
US

V. Phone/Fax

Practice location:
  • Phone: 928-356-5016
  • Fax:
Mailing address:
  • Phone: 928-356-5016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1922955640
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: