Provider Demographics
NPI:1750068961
Name:SIDHU, LOVLEEN
Entity type:Individual
Prefix:DR
First Name:LOVLEEN
Middle Name:
Last Name:SIDHU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 N JEFFERSON ST APT 111
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2995
Mailing Address - Country:US
Mailing Address - Phone:516-737-6738
Mailing Address - Fax:
Practice Address - Street 1:1437 N JEFFERSON ST APT 111
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2995
Practice Address - Country:US
Practice Address - Phone:516-737-6738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001229-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice