Provider Demographics
NPI:1043806771
Name:SANDHU, SUKHDEEP NAUNINDER SINGH
Entity Type:Individual
Prefix:
First Name:SUKHDEEP
Middle Name:NAUNINDER SINGH
Last Name:SANDHU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 SAN PABLO DAM RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94803-7202
Mailing Address - Country:US
Mailing Address - Phone:510-776-3132
Mailing Address - Fax:
Practice Address - Street 1:3380 SAN PABLO DAM RD STE A
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94803-7202
Practice Address - Country:US
Practice Address - Phone:510-776-3132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1053531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice