Provider Demographics
NPI:1467185280
Name:RAUT, SIDDHARTH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIDDHARTH
Middle Name:
Last Name:RAUT
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 1:17 CHELSEA WAY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3442
Mailing Address - Country:US
Mailing Address - Phone:908-977-7557
Mailing Address - Fax:
Practice Address - Street 1:17 CHELSEA WAY
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3442
Practice Address - Country:US
Practice Address - Phone:908-977-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02917600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist