Provider Demographics
NPI:1326695438
Name:SIDDIQUI, M SHOAIB HAIDER (BDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:M SHOAIB
Middle Name:HAIDER
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:BDS, MSD
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Mailing Address - Street 1:3500 E LAKE SAMMAMISH PARKWAY SE
Mailing Address - Street 2:UNIT 2-105
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ISSAQUAH MODERN DENTISTRY
Practice Address - Street 2:1416 HIGHLANDS DRIE NE, SUITE 120
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029
Practice Address - Country:US
Practice Address - Phone:425-557-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WADENT.DE.609369281223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics