MEDICARE: DR. GURBAZ SANDHU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	31420	TX

General Provider Information

NPI Number	:	1457720674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GURBAZ SANDHU DDS

Provider Business Mailing Address
First Line	:	10909 WEBB CHAPEL RD # 121
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-3739
Country	:	US
Telephone Number	:	408-835-3726
Fax Number	:

Provider Business Practice Location Address
First Line	:	10909 WEBB CHAPEL RD # 121
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-3739
Country	:	US
Telephone Number	:	408-835-3726
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2015
Last Update Date	:	09/17/2015

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