Provider Demographics
NPI:1659626901
Name:TAKHER, AMANDEEP (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDEEP
Middle Name:
Last Name:TAKHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:AMANI
Other - Middle Name:
Other - Last Name:TAKHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2320 SKYVIEW PL
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-8617
Mailing Address - Country:US
Mailing Address - Phone:707-631-9999
Mailing Address - Fax:
Practice Address - Street 1:2320 SKYVIEW PL
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-8617
Practice Address - Country:US
Practice Address - Phone:707-631-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA614881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice