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General NPI Number Information
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NPI Number | 1548327661
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Entity Type | Individual
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Provider Name | JAGJOT SIDHU D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 3499 N CAMPBELL AVE SUITE 902
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City | TUCSON
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State | AZ
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Zip | 85719-2376
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Country | US
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Telephone | 402-850-7405
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Fax |
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Provider Business Mailing Address
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Address Line | 3499 N CAMPBELL AVE SUITE 902
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City | TUCSON
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State | AZ
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Zip | 85719-2376
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Country | US
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Telephone | 402-850-7405
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DE00010680
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 28353
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License Number State | TX
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