Provider Demographics
NPI:1023006350
Name:SIDHU, PARDEEP KAUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PARDEEP
Middle Name:KAUR
Last Name:SIDHU
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 1:465 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1737
Mailing Address - Country:US
Mailing Address - Phone:908-352-4438
Mailing Address - Fax:908-352-4525
Practice Address - Street 1:465 NORTH AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1737
Practice Address - Country:US
Practice Address - Phone:908-352-4438
Practice Address - Fax:908-352-4525
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI222411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice