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General NPI Number Information
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NPI Number | 1942648720
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Entity Type | Individual
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Provider Name | RANDEEP SINGH SIDHU DDS
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Gender | Male
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Dates
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Enumeration Date | 06/13/2013
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 12510 PROSPERITY DR STE 220
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City | SILVER SPRING
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State | MD
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Zip | 20904-1640
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Country | US
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Telephone | 301-495-9222
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Fax | 301-495-9225
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Provider Business Mailing Address
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Address Line | 3803 VILLAGE PARK DR
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City | CHEVY CHASE
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State | MD
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Zip | 20815-5746
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Country | US
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Telephone | 301-204-6795
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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 | 15380
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License Number State | MD
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