Provider Demographics
NPI:1801588454
Name:SANDESARA, YATRI PRADIPKUMAR
Entity type:Individual
Prefix:
First Name:YATRI
Middle Name:PRADIPKUMAR
Last Name:SANDESARA
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 1:4310 TILBURY TRL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1864
Mailing Address - Country:US
Mailing Address - Phone:352-444-4618
Mailing Address - Fax:
Practice Address - Street 1:4310 TILBURY TRL
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1864
Practice Address - Country:US
Practice Address - Phone:352-444-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS108735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist