Provider Demographics
NPI:1811157217
Name:SIDHU, JASPREET SINGH (DMD)
Entity type:Individual
Prefix:DR
First Name:JASPREET
Middle Name:SINGH
Last Name:SIDHU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 NICHOLAS CT
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-1056
Mailing Address - Country:US
Mailing Address - Phone:414-305-8982
Mailing Address - Fax:
Practice Address - Street 1:8422 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1825
Practice Address - Country:US
Practice Address - Phone:414-461-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6254-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice