Provider Demographics
NPI:1720596737
Name:BHANDAL, SUKHMANDEEP KAUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUKHMANDEEP
Middle Name:KAUR
Last Name:BHANDAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 WOODWARD AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2087
Mailing Address - Country:US
Mailing Address - Phone:313-983-9608
Mailing Address - Fax:
Practice Address - Street 1:13874 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3123
Practice Address - Country:US
Practice Address - Phone:313-651-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist