Provider Demographics
NPI:1477375350
Name:PRABHJOT SIDHU, PLLC
Entity type:Organization
Organization Name:PRABHJOT SIDHU, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRABHJOT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-453-2111
Mailing Address - Street 1:5006 E LAKE SAMMAMISH PKWY SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-9220
Mailing Address - Country:US
Mailing Address - Phone:425-391-7645
Mailing Address - Fax:425-391-7699
Practice Address - Street 1:5006 E LAKE SAMMAMISH PKWY SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-9220
Practice Address - Country:US
Practice Address - Phone:425-391-7645
Practice Address - Fax:425-391-7699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty