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General NPI Number Information
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NPI Number | 1508203365
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Entity Type | Individual
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Provider Name | ANDREW SARPOTDAR D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 1619 N DYSART RD STE 105
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City | AVONDALE
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State | AZ
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Zip | 85392-1200
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Country | US
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Telephone | 623-935-6278
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Fax |
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Provider Business Mailing Address
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Address Line | 4595 FLORES AVE
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City | ROHNERT PARK
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State | CA
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Zip | 94928-1340
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Country | US
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Telephone | 858-663-4694
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D008698
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License Number State | AZ
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