Provider Demographics
NPI:1730853268
Name:SANDHU, TASNEEM (DMD)
Entity type:Individual
Prefix:
First Name:TASNEEM
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 1:9245 LAWFORD WAY APT 203
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4484
Mailing Address - Country:US
Mailing Address - Phone:732-312-8710
Mailing Address - Fax:
Practice Address - Street 1:1511 CONGRESS PKWY S
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-2803
Practice Address - Country:US
Practice Address - Phone:423-479-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist