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General NPI Number Information
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NPI Number | 1265037444
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Entity Type | Organization
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Legal Business Name | SANDHU PHAGURA DENTAL CORPORATION
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 412 S MAIN ST
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City | MILPITAS
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State | CA
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Zip | 95035-5319
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Country | US
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Telephone | 408-809-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 412 S MAIN ST
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City | MILPITAS
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State | CA
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Zip | 95035-5319
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Country | US
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Telephone | 408-809-9500
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | ROOP PHAGURA
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Credential |
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Telephone | 510-323-3704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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