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General NPI Number Information
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NPI Number | 1730853268
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Entity Type | Individual
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Provider Name | TASNEEM SANDHU DMD
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Gender | Female
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Dates
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Enumeration Date | 08/07/2021
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Last Update Date | 08/07/2021
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Provider Practice Location Address
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Address Line | 1511 CONGRESS PKWY S
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City | ATHENS
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State | TN
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Zip | 37303-2803
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Country | US
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Telephone | 423-479-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 9245 LAWFORD WAY APT 203
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City | OOLTEWAH
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State | TN
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Zip | 37363-4484
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Country | US
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Telephone | 732-312-8710
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 11695
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License Number State | TN
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