Provider Demographics
NPI:1235320292
Name:SIDDIQI, DENNIS SULTAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:SULTAN
Last Name:SIDDIQI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 TAMIAMI TRL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8134
Mailing Address - Country:US
Mailing Address - Phone:941-627-8022
Mailing Address - Fax:941-627-5147
Practice Address - Street 1:3440 TAMIAMI TRL
Practice Address - Street 2:SUITE 3
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8134
Practice Address - Country:US
Practice Address - Phone:941-627-8022
Practice Address - Fax:941-627-5147
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN172901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics