Provider Demographics
NPI:1851742696
Name:GURJOT SIDHU DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:GURJOT SIDHU DDS DENTAL CORPORATION
Other - Org Name:RIVERBANK SMILES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GURJOT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-966-4844
Mailing Address - Street 1:2119 PATTERSON RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-9639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2119 PATTERSON RD
Practice Address - Street 2:SUITE 9
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-9639
Practice Address - Country:US
Practice Address - Phone:209-315-5299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA629621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty