Provider Demographics
NPI:1114377041
Name:SIDHU, GUNNROOP (DDS)
Entity Type:Individual
Prefix:
First Name:GUNNROOP
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 1:1625 COLBY AVE
Mailing Address - Street 2:APT 104
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3077
Mailing Address - Country:US
Mailing Address - Phone:917-318-3052
Mailing Address - Fax:
Practice Address - Street 1:26938 THE OLD RD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91381-0662
Practice Address - Country:US
Practice Address - Phone:661-799-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100957122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist