Provider Demographics
NPI:1093047052
Name:LAKHANI, MOHAMMED SIDDIQUE (DDS)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:SIDDIQUE
Last Name:LAKHANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 153256
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92195-3256
Mailing Address - Country:US
Mailing Address - Phone:619-818-6253
Mailing Address - Fax:619-640-0619
Practice Address - Street 1:4619 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1901
Practice Address - Country:US
Practice Address - Phone:619-818-6253
Practice Address - Fax:619-640-0619
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31305OtherMEDI-CAL