Healthcare Provider Details

I. General information

NPI: 1720990583
Provider Name (Legal Business Name): PRABHJYOT LIDHAR DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 STANFORD RANCH RD STE 112
ROCKLIN CA
95765-4416
US

IV. Provider business mailing address

6011 STANFORD RANCH RD STE 112
ROCKLIN CA
95765-4416
US

V. Phone/Fax

Practice location:
  • Phone: 209-914-5015
  • Fax:
Mailing address:
  • Phone:
  • 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: PRABHJYOT KAUR LIDHAR
Title or Position: DENTIST
Credential: DDS
Phone: 209-914-5015