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General NPI Number Information
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NPI Number | 1902229461
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Entity Type | Individual
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Provider Name | GURSIMRAN KAUR SIDHU DMD
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Gender | Female
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Dates
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Enumeration Date | 02/03/2014
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 630 SMITHFIELD RD APT 721
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-2930
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Country | US
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Telephone | 617-306-6733
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Fax |
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Provider Business Mailing Address
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Address Line | 630 SMITHFIELD RD 721
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-2900
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Country | US
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Telephone | 617-306-7303
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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 | DN1856458
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License Number State | MA
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