Provider Demographics
NPI:1497218705
Name:HARDEEP K SIDHU DDS A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:HARDEEP K SIDHU DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HARDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-953-7975
Mailing Address - Street 1:729 SUNRISE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4504
Mailing Address - Country:US
Mailing Address - Phone:916-953-7975
Mailing Address - Fax:916-953-7987
Practice Address - Street 1:729 SUNRISE AVE STE 200
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4504
Practice Address - Country:US
Practice Address - Phone:916-953-7975
Practice Address - Fax:916-953-7987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental