Provider Demographics
NPI:1750414629
Name:SACHDEVA, KANWAR DEEP SINGH (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:KANWAR DEEP SINGH
Middle Name:
Last Name:SACHDEVA
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11229 N VIA PALERMO WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-8815
Mailing Address - Country:US
Mailing Address - Phone:559-840-3377
Mailing Address - Fax:
Practice Address - Street 1:924 EMILY WAY
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5647
Practice Address - Country:US
Practice Address - Phone:559-232-3737
Practice Address - Fax:559-675-8541
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205511223P0700X
CA583551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223P0700XDental ProvidersDentistProsthodontics