Provider Demographics
NPI:1679822860
Name:SANDHU, HARKESHWAR S
Entity Type:Individual
Prefix:
First Name:HARKESHWAR
Middle Name:S
Last Name:SANDHU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5517 ENSEMBLE WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-8939
Mailing Address - Country:US
Mailing Address - Phone:703-618-6550
Mailing Address - Fax:
Practice Address - Street 1:3171 WASHINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5831
Practice Address - Country:US
Practice Address - Phone:530-626-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039433122300000X, 122300000X
CA64180122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist