Provider Demographics
NPI:1003482589
Name:VERMA, SIDDHARTH
Entity Type:Individual
Prefix:DR
First Name:SIDDHARTH
Middle Name:
Last Name:VERMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CENTRAL PARK DR APT 508
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-1728
Mailing Address - Country:US
Mailing Address - Phone:848-219-6123
Mailing Address - Fax:
Practice Address - Street 1:5691 TINKER DIAGONAL
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-2821
Practice Address - Country:US
Practice Address - Phone:405-458-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist