Provider Demographics
NPI:1790350387
Name:SIDHU, TEJWINDER SINGH (DMD, MA, MPH)
Entity Type:Individual
Prefix:
First Name:TEJWINDER
Middle Name:SINGH
Last Name:SIDHU
Suffix:
Gender:M
Credentials:DMD, MA, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 HEATH ST APT 308
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-1168
Mailing Address - Country:US
Mailing Address - Phone:623-227-9683
Mailing Address - Fax:
Practice Address - Street 1:841 S 25TH ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5376
Practice Address - Country:US
Practice Address - Phone:610-330-9855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0431711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice