Provider Demographics
NPI:1184052482
Name:SANDHU, KABIR RAM (DMD)
Entity type:Individual
Prefix:DR
First Name:KABIR
Middle Name:RAM
Last Name:SANDHU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:KABIR
Other - Middle Name:SANDHU
Other - Last Name:RAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:6886 INDIANA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506
Mailing Address - Country:US
Mailing Address - Phone:951-686-2565
Mailing Address - Fax:951-686-4565
Practice Address - Street 1:6886 INDIANA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506
Practice Address - Country:US
Practice Address - Phone:951-686-2565
Practice Address - Fax:951-686-4565
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63061122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist