Healthcare Provider Details

I. General information

NPI: 1215098447
Provider Name (Legal Business Name): NAVDEEP SINGH SANDHU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/07/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42106 PEMBERLY CT
CHANTILLY VA
20152-5982
US

IV. Provider business mailing address

42106 PEMBERLY CT
CHANTILLY VA
20152-5982
US

V. Phone/Fax

Practice location:
  • Phone: 510-329-9554
  • Fax:
Mailing address:
  • Phone: 510-329-9554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number0401414064
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number54674
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401414064
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: