Provider Demographics
NPI:1053637884
Name:SIDHU, TEJASVI (DMD)
Entity Type:Individual
Prefix:DR
First Name:TEJASVI
Middle Name:
Last Name:SIDHU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8227 MERRIMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3919
Mailing Address - Country:US
Mailing Address - Phone:206-979-8710
Mailing Address - Fax:
Practice Address - Street 1:23805 HIGHWAY 99 STE 100
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9204
Practice Address - Country:US
Practice Address - Phone:425-778-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60133154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist