Provider Demographics
NPI:1831245141
Name:SIDHU, DALJEET S (DDS)
Entity type:Individual
Prefix:DR
First Name:DALJEET
Middle Name:S
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 1:4209 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2700
Mailing Address - Country:US
Mailing Address - Phone:718-204-9345
Mailing Address - Fax:718-204-2467
Practice Address - Street 1:4209 BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2700
Practice Address - Country:US
Practice Address - Phone:718-204-9345
Practice Address - Fax:718-204-2467
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0380971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice