Provider Demographics
NPI:1275005084
Name:SIDHU, JASJIT SINGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASJIT
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 1:5205 ROBERT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1687
Mailing Address - Country:US
Mailing Address - Phone:571-216-0017
Mailing Address - Fax:
Practice Address - Street 1:200 WESTGATE DR STE 2
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1810
Practice Address - Country:US
Practice Address - Phone:508-587-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18581931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice