MEDICARE: DR. AMANDEEP SIDHU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	60155	CA
2	1223G0001X	General Practice Dentistry	6545	NV

General Provider Information

NPI Number	:	1700182763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDEEP SIDHU DDS

Provider Business Mailing Address
First Line	:	4121 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3704
Country	:	US
Telephone Number	:	702-410-6655
Fax Number	:

Provider Business Practice Location Address
First Line	:	4121 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3704
Country	:	US
Telephone Number	:	702-410-6655
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2011
Last Update Date	:	03/07/2023

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