Provider Demographics
NPI:1740994284
Name:SANDHU DENTAL MEDICINE PLLC
Entity type:Organization
Organization Name:SANDHU DENTAL MEDICINE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IVRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-833-2232
Mailing Address - Street 1:2045 S VINEYARD STE 153
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6892
Mailing Address - Country:US
Mailing Address - Phone:480-833-2232
Mailing Address - Fax:
Practice Address - Street 1:2045 S VINEYARD STE 153
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6892
Practice Address - Country:US
Practice Address - Phone:480-833-2232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental