Active NPI
Prabhjot S Sidhu, DDS
- Dentist
- Lynnwood, WA
National Provider Identifier
1467646497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE-00010707
- Practice address
- 18910 28TH Ave W Ste 202
Lynnwood, WA 98036-4701 - Phone
- (425) 775-5557
- NPI assigned
- Sep 4, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE-00010707 | WA | Primary |
Addresses
Primary practice location
18910 28TH Ave W Ste 202
Lynnwood, WA 98036-4701
Mailing address
3870 82ND Ave SE
Mercer Island, WA 98040-3539
Phone (347) 453-2111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE-00010707 | WA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prabhjot Sidhu, PLLC | Current | Accepting new patients | |
| Nurani, Mitchell, Kim, PC | Dentist | Past | Accepting new patients |
Locations
5006 E Lake Sammamish Pkwy SE
Issaquah, WA 98029
Phone (425) 391-7645
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Issaquah, WA
- NPI 1477375350
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191283200000",
"number": "1467646497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3870 82ND AVE SE",
"city": "MERCER ISLAND",
"state": "WA",
"postal_code": "980403539",
"telephone_number": "347-453-2111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18910 28TH AVE W STE 202",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980364701",
"telephone_number": "425-775-5557"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDHU",
"first_name": "PRABHJOT",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-04",
"last_updated": "2007-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE-00010707",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.