Provider Demographics
NPI:1760857189
Name:SIDHU, GURJOT KAUR (DDS)
Entity type:Individual
Prefix:
First Name:GURJOT
Middle Name:KAUR
Last Name:SIDHU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 PATTERSON RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-9639
Mailing Address - Country:US
Mailing Address - Phone:650-966-4844
Mailing Address - Fax:
Practice Address - Street 1:2119 PATTERSON RD
Practice Address - Street 2:SUITE 9
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-9639
Practice Address - Country:US
Practice Address - Phone:650-966-4844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS62962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist