Provider Demographics
NPI:1548327661
Name:SIDHU, JAGJOT (DDS)
Entity type:Individual
Prefix:
First Name:JAGJOT
Middle Name:
Last Name:SIDHU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3499 N CAMPBELL AVE
Mailing Address - Street 2:SUITE 902
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2376
Mailing Address - Country:US
Mailing Address - Phone:402-850-7405
Mailing Address - Fax:
Practice Address - Street 1:3499 N CAMPBELL AVE
Practice Address - Street 2:SUITE 902
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2376
Practice Address - Country:US
Practice Address - Phone:402-850-7405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010680122300000X
TX283531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist