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General NPI Number Information
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NPI Number | 1477375350
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Entity Type | Organization
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Legal Business Name | PRABHJOT SIDHU, PLLC
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 5006 E LAKE SAMMAMISH PKWY SE
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City | ISSAQUAH
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State | WA
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Zip | 98029-9220
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Country | US
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Telephone | 425-391-7645
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Fax | 425-391-7699
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Provider Business Mailing Address
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Address Line | 5006 E LAKE SAMMAMISH PKWY SE
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City | ISSAQUAH
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State | WA
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Zip | 98029-9220
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Country | US
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Telephone | 425-391-7645
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Fax | 425-391-7699
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Authorized Official
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Title or Position | OWNER
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Name | PRABHJOT SIDHU
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Credential | DDS
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Telephone | 347-453-2111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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