Provider Demographics
NPI:1053953372
Name:INDRA SIDHU DDS
Entity type:Organization
Organization Name:INDRA SIDHU DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MUNSHA
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-498-0002
Mailing Address - Street 1:208 CRAIN HWY SW
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21032
Mailing Address - Country:US
Mailing Address - Phone:410-553-0651
Mailing Address - Fax:
Practice Address - Street 1:208 CRAIN HWY SW
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21032
Practice Address - Country:US
Practice Address - Phone:410-553-0651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental