Provider Demographics
NPI:1427188630
Name:SIDDIQUI, BUSHRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BUSHRA
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MAIN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-2614
Mailing Address - Country:US
Mailing Address - Phone:914-997-9000
Mailing Address - Fax:914-428-6537
Practice Address - Street 1:201 E 104TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5418
Practice Address - Country:US
Practice Address - Phone:212-348-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO2312400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist