Provider Demographics
NPI:1629231857
Name:SIDHU, JATINDERJEET (DMD)
Entity Type:Individual
Prefix:
First Name:JATINDERJEET
Middle Name:
Last Name:SIDHU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JATINDERJEET
Other - Middle Name:
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:684 WASHINGTON ST
Mailing Address - Street 2:STE - 200
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-4212
Mailing Address - Country:US
Mailing Address - Phone:617-515-5080
Mailing Address - Fax:781-297-9993
Practice Address - Street 1:698 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3360
Practice Address - Country:US
Practice Address - Phone:857-492-6269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice