Provider Demographics
NPI:1639653736
Name:DR MANPREET SIDHU DMD INC
Entity Type:Organization
Organization Name:DR MANPREET SIDHU DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANPREET
Authorized Official - Middle Name:K
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-401-1053
Mailing Address - Street 1:5045 HAVEN PL APT 215
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7933
Mailing Address - Country:US
Mailing Address - Phone:360-440-4028
Mailing Address - Fax:
Practice Address - Street 1:2430 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2016
Practice Address - Country:US
Practice Address - Phone:617-401-1053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental