Active NPI
Shelley Sidhu, DDS
- General Practice Dentistry
- Woodbury, MN
National Provider Identifier
1487215851
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D14225
- Practice address
- 4021 Benjamin Dr Woodbury
Woodbury, MN 55129-5512 - Phone
- (763) 515-2593
- NPI assigned
- Jun 25, 2019
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D14225 | MN | Primary |
Addresses
Primary practice location
4021 Benjamin Dr Woodbury
Woodbury, MN 55129-5512
Mailing address
7300 Gallagher Dr Apt 320
Edina, MN 55435-3126
Phone (612) 222-2644
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 |
|---|---|---|---|
| D14225 | MN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609200000000",
"number": "1487215851",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7300 GALLAGHER DR APT 320",
"city": "EDINA",
"state": "MN",
"postal_code": "554353126",
"telephone_number": "612-222-2644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4021 BENJAMIN DR WOODBURY",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551295512",
"telephone_number": "763-515-2593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDHU",
"first_name": "SHELLEY",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-06-25",
"last_updated": "2020-12-29",
"certification_date": "2020-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "D14225",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.