MEDICARE: DR. SUKHDEV SINGH SIDHU D.D.S.

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	29584	TX
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	29584	TX
3	1223D0004X	Dental Anesthesiology	29584	TX

General Provider Information

NPI Number	:	1881904258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUKHDEV SINGH SIDHU D.D.S.

Provider Business Mailing Address
First Line	:	2500 NE GREEN OAKS BLVD
Second Line	:	STE. 102
City	:	ARLINGTON
State	:	TX
Zip	:	76006-3002
Country	:	US
Telephone Number	:	817-633-4444
Fax Number	:	817-549-4239

Provider Business Practice Location Address
First Line	:	2500 NE GREEN OAKS BLVD
Second Line	:	STE. 102
City	:	ARLINGTON
State	:	TX
Zip	:	76006-3002
Country	:	US
Telephone Number	:	817-633-4444
Fax Number	:	817-549-4239

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

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	01/03/2023

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