Healthcare Provider Details

I. General information

NPI: 1104951359
Provider Name (Legal Business Name): KULWANT SINGH SISODIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 N 1ST ST STE 133
FRESNO CA
93726-0517
US

IV. Provider business mailing address

4747 N 1ST ST STE 133
FRESNO CA
93726-0517
US

V. Phone/Fax

Practice location:
  • Phone: 559-226-7846
  • Fax: 559-226-9600
Mailing address:
  • Phone: 559-226-7846
  • Fax: 559-226-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number46971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: