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General NPI Number Information
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NPI Number | 1679710883
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Entity Type | Organization
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Legal Business Name | P.S.SIDHU & ASSOCIATES
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Dates
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Enumeration Date | 01/09/2009
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 1417 S 108TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53214-4012
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Country | US
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Telephone | 414-771-5588
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Fax | 414-771-3564
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Provider Business Mailing Address
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Address Line | 1417 S 108TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53214-4012
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Country | US
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Telephone | 414-771-5588
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Fax | 414-771-3564
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | HELENE FRANK
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Credential |
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Telephone | 414-771-5588
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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 | 2560
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License Number State | WI
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