Provider Demographics
NPI:1437565199
Name:SANDHU, GURKAMAL KAUR (BDS, DDS)
Entity Type:Individual
Prefix:
First Name:GURKAMAL
Middle Name:KAUR
Last Name:SANDHU
Suffix:
Gender:F
Credentials:BDS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 E ROSEVILLE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7976
Mailing Address - Country:US
Mailing Address - Phone:646-483-5970
Mailing Address - Fax:
Practice Address - Street 1:1895 E ROSEVILLE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7976
Practice Address - Country:US
Practice Address - Phone:646-483-5970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100869122300000X
PADS0400441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice