Provider Demographics
NPI:1912223058
Name:SACHDEV, MANU MOHAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MANU
Middle Name:MOHAN
Last Name:SACHDEV
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 S HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2807
Mailing Address - Country:US
Mailing Address - Phone:801-467-2345
Mailing Address - Fax:
Practice Address - Street 1:52 N 1100 W
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2181
Practice Address - Country:US
Practice Address - Phone:302-690-3670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18942122300000X
UT11137169-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist