Healthcare Provider Details

I. General information

NPI: 1538167671
Provider Name (Legal Business Name): SANDHU PANDE DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 S MAIN ST
MILPITAS CA
95035-5319
US

IV. Provider business mailing address

414 S MAIN ST
MILPITAS CA
95035-5319
US

V. Phone/Fax

Practice location:
  • Phone: 408-934-0693
  • Fax: 408-934-1055
Mailing address:
  • Phone: 408-934-0693
  • Fax: 408-934-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53104
License Number StateCA

VIII. Authorized Official

Name: DR. PUNEET SANDHU
Title or Position: CEO
Credential: DDS
Phone: 510-825-0445