Provider Demographics
NPI:1750036422
Name:RANDEEP SIDHU DDS, LLC
Entity Type:Organization
Organization Name:RANDEEP SIDHU DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-495-9222
Mailing Address - Street 1:12510 PROSPERITY DR STE 220
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1640
Mailing Address - Country:US
Mailing Address - Phone:301-495-9222
Mailing Address - Fax:
Practice Address - Street 1:12510 PROSPERITY DR STE 220
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1640
Practice Address - Country:US
Practice Address - Phone:301-204-6795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty