MEDICARE: SANDEEP 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	DS038722	PA

General Provider Information

NPI Number	:	1619264249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDEEP SANDHU DDS

Provider Business Mailing Address
First Line	:	295 THRUSH DR
Second Line	:
City	:	HUMMELSTOWN
State	:	PA
Zip	:	17036-8835
Country	:	US
Telephone Number	:	443-812-8823
Fax Number	:

Provider Business Practice Location Address
First Line	:	1829 MARKET ST
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17103-2524
Country	:	US
Telephone Number	:	717-236-0300
Fax Number	:

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

Provider Enumeration Date	:	07/04/2011
Last Update Date	:	07/04/2011

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