Provider Demographics
NPI:1467053660
Name:GURJOT SIDHU DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:GURJOT SIDHU DDS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GURJOT
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-502-7770
Mailing Address - Street 1:2701 E HAMMER LN STE 101
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-4245
Mailing Address - Country:US
Mailing Address - Phone:209-502-7770
Mailing Address - Fax:
Practice Address - Street 1:2701 E HAMMER LN STE 101
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-4245
Practice Address - Country:US
Practice Address - Phone:209-502-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GURJOT SIDHU DDS DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty