Provider Demographics
NPI:1255450961
Name:SIDEL, EDWARD VICTOR (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:VICTOR
Last Name:SIDEL
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 1:250 BEISER BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7795
Mailing Address - Country:US
Mailing Address - Phone:302-735-4800
Mailing Address - Fax:302-735-1844
Practice Address - Street 1:250 BEISER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7795
Practice Address - Country:US
Practice Address - Phone:302-735-4800
Practice Address - Fax:302-735-1844
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00010131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice