Provider Demographics
NPI:1750448650
Name:JESSY S. SIDHU, DMD PROF. CORP.
Entity Type:Organization
Organization Name:JESSY S. SIDHU, DMD PROF. CORP.
Other - Org Name:DEL MAR HIGHLANDS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSY
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-860-7600
Mailing Address - Street 1:12925 EL CAMINO REAL STE J22
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1893
Mailing Address - Country:US
Mailing Address - Phone:858-350-1005
Mailing Address - Fax:858-350-1004
Practice Address - Street 1:12925 EL CAMINO REAL STE J22
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-1893
Practice Address - Country:US
Practice Address - Phone:858-350-1005
Practice Address - Fax:858-350-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48549122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty