Provider Demographics
NPI:1093035842
Name:TALSANIA, SIDDHARTH JAWAHAR
Entity Type:Individual
Prefix:
First Name:SIDDHARTH
Middle Name:JAWAHAR
Last Name:TALSANIA
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 1:5306 CARNABY ST
Mailing Address - Street 2:APT 219
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6907
Mailing Address - Country:US
Mailing Address - Phone:201-962-5555
Mailing Address - Fax:
Practice Address - Street 1:3030 LBJ
Practice Address - Street 2:SUITE 1400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7781
Practice Address - Country:US
Practice Address - Phone:682-747-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59295122300000X
TX26425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist