Provider Demographics
NPI:1851276133
Name:SG1 DENTAL LLC
Entity type:Organization
Organization Name:SG1 DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEEPSHIKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:240-351-9132
Mailing Address - Street 1:121 SHILLING AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3268
Mailing Address - Country:US
Mailing Address - Phone:240-351-9132
Mailing Address - Fax:
Practice Address - Street 1:121 SHILLING AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3268
Practice Address - Country:US
Practice Address - Phone:240-351-9132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental