Healthcare Provider Details

I. General information

NPI: 1639653736
Provider Name (Legal Business Name): DR MANPREET SIDHU DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 WEBSTER ST
BERKELEY CA
94705-2016
US

IV. Provider business mailing address

5045 HAVEN PL APT 215
DUBLIN CA
94568-7933
US

V. Phone/Fax

Practice location:
  • Phone: 617-401-1053
  • Fax:
Mailing address:
  • Phone: 360-440-4028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MANPREET K SIDHU
Title or Position: PRESIDENT
Credential:
Phone: 617-401-1053