Provider Demographics
NPI:1073630570
Name:GARG, SANDEEP KUMAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:KUMAR
Last Name:GARG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 EDENVALE CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3189
Mailing Address - Country:US
Mailing Address - Phone:301-638-3198
Mailing Address - Fax:
Practice Address - Street 1:112 SMALLWOOD VILLAGE CTR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1843
Practice Address - Country:US
Practice Address - Phone:301-843-8088
Practice Address - Fax:301-645-3217
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129471223G0001X
FLDN154081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD011144900Medicaid