Healthcare Provider Details

I. General information

NPI: 1750267324
Provider Name (Legal Business Name): SEJAL SIDHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CITY CTR
OSHKOSH WI
54901-4830
US

IV. Provider business mailing address

119 N MCCARTHY RD STE S
APPLETON WI
54913-9111
US

V. Phone/Fax

Practice location:
  • Phone: 920-731-7445
  • Fax: 920-651-3485
Mailing address:
  • Phone: 920-731-7445
  • Fax: 920-404-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6001836-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: