Healthcare Provider Details

I. General information

NPI: 1902229461
Provider Name (Legal Business Name): GURSIMRAN KAUR SIDHU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GURSIMRAN KAUR

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 HANCOCK ST
QUINCY MA
02171-2442
US

IV. Provider business mailing address

468 ELM ST E
RAYNHAM MA
02767-1827
US

V. Phone/Fax

Practice location:
  • Phone: 617-328-0790
  • Fax:
Mailing address:
  • Phone: 617-306-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1856458
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: