Organization
SIDHU FAMILY DENTAL LLC
Active
Other names
Douglas Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASJIT SINGH SIDHU DDS (MANAGER)
(508) 476-2828
Entity
Organization
Contact information
Practice address
15 WEST ST STE 101, DOUGLAS, MA 01516-2160
(508) 476-2828
Mailing address
15 WEST ST STE 101, DOUGLAS, MA 01516-2160
(508) 476-2828
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275005084
—
MA
Enumeration date
11/04/2020
Last updated
11/04/2020
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