Provider Demographics
NPI:1285361782
Name:SIDHWA, ZAL (DMD)
Entity type:Individual
Prefix:DR
First Name:ZAL
Middle Name:
Last Name:SIDHWA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 PEBBLE BEACH BLVD APT 302
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-8344
Mailing Address - Country:US
Mailing Address - Phone:781-796-2032
Mailing Address - Fax:
Practice Address - Street 1:9132 STRADA PL STE 11101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2968
Practice Address - Country:US
Practice Address - Phone:239-206-4282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL273681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice