Healthcare Provider Details

I. General information

NPI: 1326442187
Provider Name (Legal Business Name): SARPOTDAR ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13775 N. LITCHFIELD RD SUITE 108
SURPRISE AZ
85379
US

IV. Provider business mailing address

20435 N 7TH ST #2019
PHOENIX AZ
85024-6024
US

V. Phone/Fax

Practice location:
  • Phone: 858-663-4694
  • Fax:
Mailing address:
  • Phone: 858-663-4694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD008698
License Number StateAZ

VIII. Authorized Official

Name: DR. ANDREW P SARPOTDAR
Title or Position: ORTHODONTIST
Credential: D.D.S., M.S.
Phone: 858-663-4694