Healthcare Provider Details

I. General information

NPI: 1548758113
Provider Name (Legal Business Name): NISHA KAUR SANDHU BDS BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2018
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 BROADWAY E AVENUE
SEATTLE WA
98102-5023
US

IV. Provider business mailing address

2224 KAMBER RD
BELLEVUE WA
98007-6229
US

V. Phone/Fax

Practice location:
  • Phone: 206-829-4333
  • Fax:
Mailing address:
  • Phone: 425-829-3542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60989146
License Number StateWA
# 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: