Provider Demographics
NPI:1942648720
Name:SIDHU, RANDEEP SINGH (DDS)
Entity Type:Individual
Prefix:
First Name:RANDEEP
Middle Name:SINGH
Last Name:SIDHU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 VILLAGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5746
Mailing Address - Country:US
Mailing Address - Phone:301-204-6795
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:301-495-9222
Practice Address - Fax:301-495-9225
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist