Provider Demographics
NPI:1962099036
Name:SANDHU, KIRANDEEP KAUR (DDS)
Entity type:Individual
Prefix:DR
First Name:KIRANDEEP
Middle Name:KAUR
Last Name:SANDHU
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 1:1830 OREGANO WAY
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-6727
Mailing Address - Country:US
Mailing Address - Phone:510-298-8762
Mailing Address - Fax:
Practice Address - Street 1:5430 EL PASO DR
Practice Address - Street 2:SUITE K
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905
Practice Address - Country:US
Practice Address - Phone:858-740-4062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX368341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice