Provider Demographics
NPI:1497114839
Name:SIDDIQUI, WAJIHA TARIQ (DMD)
Entity Type:Individual
Prefix:DR
First Name:WAJIHA
Middle Name:TARIQ
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:WAJIHA
Other - Middle Name:SEHRISH
Other - Last Name:TARIQ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 FAYETTEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2325
Mailing Address - Country:US
Mailing Address - Phone:919-956-4000
Mailing Address - Fax:
Practice Address - Street 1:1301 FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2325
Practice Address - Country:US
Practice Address - Phone:919-956-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-13
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10835122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1497114839Medicaid