Provider Demographics
NPI:1194834283
Name:SACHDEVA, AMANDEEP (DDS)
Entity Type:Individual
Prefix:
First Name:AMANDEEP
Middle Name:
Last Name:SACHDEVA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11995 COUNTY ROAD 11 STE 110
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5106
Mailing Address - Country:US
Mailing Address - Phone:201-377-8608
Mailing Address - Fax:952-426-0657
Practice Address - Street 1:11995 COUNTY ROAD 11 STE 110
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5106
Practice Address - Country:US
Practice Address - Phone:201-377-8608
Practice Address - Fax:952-426-0960
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN490638100Medicaid