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General NPI Number Information
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NPI Number | 1942783782
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Entity Type | Organization
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Legal Business Name | GURJOT SIDHU DDS DENTAL CORPORATION
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 09/07/2018
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Provider Practice Location Address
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Address Line | 2119 PATTERSON RD STE 9
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City | RIVERBANK
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State | CA
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Zip | 95367-9639
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Country | US
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Telephone | 650-966-4844
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Fax |
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Provider Business Mailing Address
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Address Line | 2119 PATTERSON RD STE 9
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City | RIVERBANK
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State | CA
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Zip | 95367-9639
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Country | US
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Telephone | 650-966-4844
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GURJOT KAUR SIDHU
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Credential | DDS
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Telephone | 650-966-4844
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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 | 62962
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License Number State | CA
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