Provider Demographics
NPI:1710207311
Name:SANDHU, MANDEEP SINGH (DDS)
Entity Type:Individual
Prefix:
First Name:MANDEEP
Middle Name:SINGH
Last Name:SANDHU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-3512
Mailing Address - Country:US
Mailing Address - Phone:559-896-8888
Mailing Address - Fax:559-896-4904
Practice Address - Street 1:2059 HIGH ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3512
Practice Address - Country:US
Practice Address - Phone:559-896-8888
Practice Address - Fax:559-896-4904
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA592061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice