Provider Demographics
NPI:1588398457
Name:SANDHU, GARIMA
Entity type:Individual
Prefix:
First Name:GARIMA
Middle Name:
Last Name:SANDHU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 FREEDOM BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5018
Mailing Address - Country:US
Mailing Address - Phone:979-985-5505
Mailing Address - Fax:979-475-1319
Practice Address - Street 1:3203 FREEDOM BLVD STE 400
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5018
Practice Address - Country:US
Practice Address - Phone:979-985-5505
Practice Address - Fax:979-475-1319
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX387191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty