Provider Demographics
NPI:1477032035
Name:DESHPANDE, SAMPADA JAYANT (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMPADA
Middle Name:JAYANT
Last Name:DESHPANDE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 MILDRED ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6134
Mailing Address - Country:US
Mailing Address - Phone:253-566-0900
Mailing Address - Fax:
Practice Address - Street 1:4811 WA TAU GA AVE NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1799
Practice Address - Country:US
Practice Address - Phone:253-927-9883
Practice Address - Fax:253-925-2153
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1030611223G0001X
WA608613861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice