Provider Demographics
NPI:1205971918
Name:BEHNIWAL, AMANDEEP (DDS)
Entity type:Individual
Prefix:DR
First Name:AMANDEEP
Middle Name:
Last Name:BEHNIWAL
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 1:1700 ROCKY RIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2818
Mailing Address - Country:US
Mailing Address - Phone:916-782-6001
Mailing Address - Fax:916-782-9243
Practice Address - Street 1:1700 ROCKY RIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2818
Practice Address - Country:US
Practice Address - Phone:916-782-6001
Practice Address - Fax:916-782-9243
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA456471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice