Healthcare Provider Details

I. General information

NPI: 1063874709
Provider Name (Legal Business Name): HARSHEEN SIDHU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W ONTARIO AVE STE 102
CORONA CA
92882-5274
US

IV. Provider business mailing address

5037 LIPIZZAN PLACE
RANCHO CUCAMONGA CA
91737
US

V. Phone/Fax

Practice location:
  • Phone: 951-898-9700
  • Fax:
Mailing address:
  • Phone: 909-614-3552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number104052
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: