Provider Demographics
NPI:1083331185
Name:SANDEEP POTDAR, DDS, INC
Entity Type:Organization
Organization Name:SANDEEP POTDAR, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:P
Authorized Official - Last Name:POTDAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-280-1288
Mailing Address - Street 1:1720 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5424
Mailing Address - Country:US
Mailing Address - Phone:786-280-1288
Mailing Address - Fax:
Practice Address - Street 1:1720 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5424
Practice Address - Country:US
Practice Address - Phone:786-280-1288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty