Provider Demographics
NPI:1073246401
Name:SANDHU, PRABHDEEP KAUR
Entity Type:Individual
Prefix:
First Name:PRABHDEEP
Middle Name:KAUR
Last Name:SANDHU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-1313
Mailing Address - Country:US
Mailing Address - Phone:716-803-9810
Mailing Address - Fax:
Practice Address - Street 1:3755 7TH TER STE 303
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6547
Practice Address - Country:US
Practice Address - Phone:772-226-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-04
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN270271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice