Provider Demographics
NPI:1659880805
Name:GURKAMAL SANDHU DDS, INC.
Entity Type:Organization
Organization Name:GURKAMAL SANDHU DDS, INC.
Other - Org Name:GURKAMAL SANDHU DDS,INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GURKAMAL
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-483-5970
Mailing Address - Street 1:1895 E ROSEVILLE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7977
Mailing Address - Country:US
Mailing Address - Phone:916-789-8766
Mailing Address - Fax:
Practice Address - Street 1:1895 E ROSEVILLE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7977
Practice Address - Country:US
Practice Address - Phone:916-789-8766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS100869261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental