Provider Demographics
NPI:1508203365
Name:SARPOTDAR, ANDREW (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:SARPOTDAR
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4595 FLORES AVE
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-1340
Mailing Address - Country:US
Mailing Address - Phone:858-663-4694
Mailing Address - Fax:
Practice Address - Street 1:1619 N DYSART RD STE 105
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1200
Practice Address - Country:US
Practice Address - Phone:623-935-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0086981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics