Provider Demographics
NPI:1184198061
Name:SANDHU, ANMOLJIT KAUR (RDH)
Entity Type:Individual
Prefix:
First Name:ANMOLJIT
Middle Name:KAUR
Last Name:SANDHU
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2399 MEGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-5081
Mailing Address - Country:US
Mailing Address - Phone:559-309-3352
Mailing Address - Fax:
Practice Address - Street 1:1010 SHAW AVE STE B
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3950
Practice Address - Country:US
Practice Address - Phone:559-777-6113
Practice Address - Fax:559-323-4301
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21841124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist