Provider Demographics
NPI:1568546927
Name:SANDHU, AMANDEEP DHALIWAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDEEP
Middle Name:DHALIWAL
Last Name:SANDHU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 CYPRESS VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6801
Mailing Address - Country:US
Mailing Address - Phone:813-655-9944
Mailing Address - Fax:813-655-9945
Practice Address - Street 1:767 CYPRESS VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6801
Practice Address - Country:US
Practice Address - Phone:813-655-9944
Practice Address - Fax:813-655-9945
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL176561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice