Provider Demographics
NPI:1235203761
Name:SIDKY, HAYDI ROBEIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAYDI
Middle Name:ROBEIR
Last Name:SIDKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:HAYDI
Other - Middle Name:ROBEIR
Other - Last Name:MICKAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:557 PRAIRIE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5379
Mailing Address - Country:US
Mailing Address - Phone:952-405-8838
Mailing Address - Fax:
Practice Address - Street 1:557 PRAIRIE CENTER DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5379
Practice Address - Country:US
Practice Address - Phone:952-405-8838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120561223G0001X
MND12056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN988179400Medicaid