Provider Demographics
NPI:1871091173
Name:MANN, SANDEEP KAUR (RDHAP)
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:KAUR
Last Name:MANN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3384 AMY DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-8794
Mailing Address - Country:US
Mailing Address - Phone:209-534-7959
Mailing Address - Fax:
Practice Address - Street 1:3384 AMY DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-8794
Practice Address - Country:US
Practice Address - Phone:120-953-4795
Practice Address - Fax:209-534-7959
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP674125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP674OtherRDHAP