Provider Demographics
NPI:1760620660
Name:KAUR, SANDEEP (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12950 HIGHLAND CROSSING DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-5888
Mailing Address - Country:US
Mailing Address - Phone:703-787-9670
Mailing Address - Fax:
Practice Address - Street 1:12950 HIGHLAND CROSSING DR
Practice Address - Street 2:SUITE F
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-5888
Practice Address - Country:US
Practice Address - Phone:703-787-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10530122300000X
VA0401414567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADL11941OtherDENTAL LICENCE
MADL 10530OtherDENTAL LICENSE