Provider Demographics
NPI:1053201897
Name:LIDHAR, PRABHJYOT KAUR (DDS)
Entity type:Individual
Prefix:
First Name:PRABHJYOT
Middle Name:KAUR
Last Name:LIDHAR
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 1:1830 OREGANO WAY
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-6727
Mailing Address - Country:US
Mailing Address - Phone:209-914-5015
Mailing Address - Fax:
Practice Address - Street 1:8324 ELK GROVE FLORIN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-9546
Practice Address - Country:US
Practice Address - Phone:209-914-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111882122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist