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General NPI Number Information
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NPI Number | 1073503496
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Entity Type | Organization
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Legal Business Name | DALJEET SINGH SIDHU DENTIST P.C.
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4209 BROADWAY
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City | ASTORIA
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State | NY
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Zip | 11103-2700
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Country | US
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Telephone | 718-204-9345
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Fax | 718-204-2467
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Provider Business Mailing Address
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Address Line | 4209 BROADWAY
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City | ASTORIA
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State | NY
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Zip | 11103-2700
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Country | US
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Telephone | 718-204-9345
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Fax | 718-204-2467
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DALJEET SINGH SIDHU
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Credential | DDS
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Telephone | 718-204-9345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 038097
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License Number State | NY
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