Provider Demographics
NPI:1487295747
Name:SANDHU, SIMRATA (DMD)
Entity type:Individual
Prefix:DR
First Name:SIMRATA
Middle Name:
Last Name:SANDHU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 DEVINE ST STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3617
Mailing Address - Country:US
Mailing Address - Phone:803-432-2817
Mailing Address - Fax:
Practice Address - Street 1:4600 DEVINE ST STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-3617
Practice Address - Country:US
Practice Address - Phone:803-432-2817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190306621223G0001X
SC100301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice