Provider Demographics
NPI:1053715235
Name:SINGH, SUKHDEV (DMD)
Entity type:Individual
Prefix:DR
First Name:SUKHDEV
Middle Name:
Last Name:SINGH
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 1:126 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-5116
Mailing Address - Country:US
Mailing Address - Phone:617-201-0535
Mailing Address - Fax:
Practice Address - Street 1:302 CENTRAL ST # 1
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-2389
Practice Address - Country:US
Practice Address - Phone:617-201-0535
Practice Address - Fax:617-201-0535
Is Sole Proprietor?:No
Enumeration Date:2014-10-16
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858133122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist