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General NPI Number Information
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NPI Number | 1831753177
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Entity Type | Individual
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Provider Name | EDIRIN ELAINE SIDO DMD
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Gender | Female
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 4135 BLACKHAWK PLAZA CIR STE 260
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City | DANVILLE
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State | CA
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Zip | 94506-4655
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Country | US
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Telephone | 925-837-7745
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2357
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City | DUBLIN
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State | CA
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Zip | 94568-0235
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D11121
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DB-2023-0058
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D11121
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 106959
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License Number State | CA
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