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General NPI Number Information
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NPI Number | 1295513919
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Entity Type | Organization
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Legal Business Name | AMANDEEP S. SIDHU PROFESSIONAL CORP
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Dates
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Enumeration Date | 09/15/2023
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 8955 S PECOS RD STE 2A
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City | HENDERSON
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State | NV
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Zip | 89074-7157
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Country | US
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Telephone | 702-212-6641
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Fax | 702-307-7969
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Provider Business Mailing Address
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Address Line | 8955 S PECOS RD STE 2A
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City | HENDERSON
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State | NV
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Zip | 89074-7157
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Country | US
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Telephone | 702-212-6641
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Fax | 702-307-7969
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. AMANDEEP SIDHU
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Credential | DDS
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Telephone | 702-212-6641
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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 |
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License Number State |
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