Provider Demographics
NPI:1295513919
Name:AMANDEEP S. SIDHU PROFESSIONAL CORP
Entity type:Organization
Organization Name:AMANDEEP S. SIDHU PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-212-6641
Mailing Address - Street 1:8955 S PECOS RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7157
Mailing Address - Country:US
Mailing Address - Phone:702-212-6641
Mailing Address - Fax:702-307-7969
Practice Address - Street 1:8955 S PECOS RD STE 2A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7157
Practice Address - Country:US
Practice Address - Phone:702-212-6641
Practice Address - Fax:702-307-7969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty