Provider Demographics
NPI:1356649198
Name:SIDHU, GAGANDEEP SINGH (DDS)
Entity Type:Individual
Prefix:
First Name:GAGANDEEP
Middle Name:SINGH
Last Name:SIDHU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-3608
Mailing Address - Country:US
Mailing Address - Phone:559-673-4075
Mailing Address - Fax:
Practice Address - Street 1:2401 W CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-3608
Practice Address - Country:US
Practice Address - Phone:559-673-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA602091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice