Provider Demographics
NPI:1699076307
Name:INDRA SIDHU DDS
Entity type:Organization
Organization Name:INDRA SIDHU DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:INDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-498-0002
Mailing Address - Street 1:208 CRAIN HWY S
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3530
Mailing Address - Country:US
Mailing Address - Phone:410-553-0651
Mailing Address - Fax:410-510-1009
Practice Address - Street 1:208 CRAIN HWY S
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3530
Practice Address - Country:US
Practice Address - Phone:410-553-0651
Practice Address - Fax:410-510-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD112951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty