Provider Demographics
NPI:1598065930
Name:SANDEEP SINGH CHEEMA DDS INC
Entity Type:Organization
Organization Name:SANDEEP SINGH CHEEMA DDS INC
Other - Org Name:FRIENDLY DENTAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMADA
Authorized Official - Middle Name:
Authorized Official - Last Name:KULICK
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:951-836-1239
Mailing Address - Street 1:39252 WINCHESTER RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3509
Mailing Address - Country:US
Mailing Address - Phone:951-894-7769
Mailing Address - Fax:
Practice Address - Street 1:39252 WINCHESTER RD
Practice Address - Street 2:SUITE 117
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-3509
Practice Address - Country:US
Practice Address - Phone:951-894-7769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700928223Medicaid
CA1467761569OtherRECENTLY APPROVED NPI FOR THE TEMECULA BUSINESS LOCATION