Healthcare Provider Details

I. General information

NPI: 1760161319
Provider Name (Legal Business Name): SANDIPTA HALDAR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST STE L328
DAYTON OH
45409-2939
US

IV. Provider business mailing address

30 E APPLE ST STE L328
DAYTON OH
45409-2939
US

V. Phone/Fax

Practice location:
  • Phone: 937-640-3388
  • Fax:
Mailing address:
  • Phone: 937-640-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.027752
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: