Provider Demographics
NPI:1386324853
Name:SIDHWA, ZARIR SOHRAB
Entity type:Individual
Prefix:
First Name:ZARIR
Middle Name:SOHRAB
Last Name:SIDHWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W WASHINGTON ST APT 1906
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-3481
Mailing Address - Country:US
Mailing Address - Phone:781-654-6009
Mailing Address - Fax:
Practice Address - Street 1:9704 GRAND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-3357
Practice Address - Country:US
Practice Address - Phone:847-260-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019034396122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist