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General NPI Number Information
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NPI Number | 1518121730
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Entity Type | Organization
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Legal Business Name | SANDHU DENTISTRY
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 4757 HOEN AVE
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City | SANTA ROSA
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State | CA
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Zip | 95405-7862
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Country | US
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Telephone | 707-575-9595
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Fax | 707-575-5122
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Provider Business Mailing Address
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Address Line | 4757 HOEN AVE
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City | SANTA ROSA
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State | CA
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Zip | 95405-7862
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Country | US
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Telephone | 707-575-9595
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Fax | 707-575-5122
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Authorized Official
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Title or Position | FINANCIAL OFFICER
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Name | MS. KAMALDEEP SANDHU
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Credential | DDS
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Telephone | 707-575-9595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 43070
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License Number State | CA
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