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General NPI Number Information
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NPI Number | 1912223058
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Entity Type | Individual
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Provider Name | MANU MOHAN SACHDEV D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2010
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Last Update Date | 04/24/2019
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Provider Practice Location Address
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Address Line | 52 N 1100 W
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City | FARMINGTON
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State | UT
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Zip | 84025-2181
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Country | US
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Telephone | 302-690-3670
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Fax |
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Provider Business Mailing Address
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Address Line | 2114 S HIGHLAND DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-2807
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Country | US
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Telephone | 801-467-2345
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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 | DN18942
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11137169-9921
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License Number State | UT
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