Healthcare Provider Details

I. General information

NPI: 1407548449
Provider Name (Legal Business Name): MANVEER SANDHAWALIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 W CYPRESS CREEK RD STE 201
FORT LAUDERDALE FL
33309-1866
US

IV. Provider business mailing address

9019 LIMA RD
FORT WAYNE IN
46818-1801
US

V. Phone/Fax

Practice location:
  • Phone: 954-451-2290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12014085A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: