Healthcare Provider Details

I. General information

NPI: 1922932979
Provider Name (Legal Business Name): KEVIN SANDHU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 SOUTHEASTERN AVE
INDIANAPOLIS IN
46239-1207
US

IV. Provider business mailing address

653 TIMELESS RUN
GREENWOOD IN
46143-6562
US

V. Phone/Fax

Practice location:
  • Phone: 317-204-8096
  • Fax:
Mailing address:
  • Phone: 317-441-1478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12015034A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: