Provider Demographics
NPI:1952053340
Name:SANDHU, PAVITERJOT KAUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAVITERJOT
Middle Name:KAUR
Last Name:SANDHU
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 1:27831 NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-8204
Mailing Address - Country:US
Mailing Address - Phone:916-544-9697
Mailing Address - Fax:
Practice Address - Street 1:7610 ELK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-6493
Practice Address - Country:US
Practice Address - Phone:916-582-6596
Practice Address - Fax:916-582-6597
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107271122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist