Provider Demographics
NPI:1629769278
Name:KASHAT, SANDRA VICTOR (DDS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:VICTOR
Last Name:KASHAT
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 1:7180 AUTUMN HILL DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2073
Mailing Address - Country:US
Mailing Address - Phone:248-974-6011
Mailing Address - Fax:
Practice Address - Street 1:8362 RICHARDSON RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4642
Practice Address - Country:US
Practice Address - Phone:248-974-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601746122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist