Provider Demographics
NPI:1043686959
Name:SIDHU, ROOHAN (DDS)
Entity Type:Individual
Prefix:MISS
First Name:ROOHAN
Middle Name:
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 1:215 WILLIAM PENN PLZ
Mailing Address - Street 2:APT 1003
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2545
Mailing Address - Country:US
Mailing Address - Phone:904-514-5701
Mailing Address - Fax:
Practice Address - Street 1:240 SPENCER ST
Practice Address - Street 2:DR DENTAL
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4618
Practice Address - Country:US
Practice Address - Phone:860-645-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist