Provider Demographics
NPI:1902229461
Name:SIDHU, GURSIMRAN KAUR (DMD)
Entity Type:Individual
Prefix:
First Name:GURSIMRAN
Middle Name:KAUR
Last Name:SIDHU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:GURSIMRAN
Other - Middle Name:
Other - Last Name:KAUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 SMITHFIELD RD
Mailing Address - Street 2:721
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2900
Mailing Address - Country:US
Mailing Address - Phone:617-306-7303
Mailing Address - Fax:
Practice Address - Street 1:630 SMITHFIELD RD APT 721
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2930
Practice Address - Country:US
Practice Address - Phone:617-306-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18564581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice