Provider Demographics
NPI:1497231526
Name:SIDDIQUI, OMAR KABIR (DMD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:KABIR
Last Name:SIDDIQUI
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 1:16810 MERIDIAN E STE J107
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-9604
Mailing Address - Country:US
Mailing Address - Phone:253-848-7777
Mailing Address - Fax:
Practice Address - Street 1:16810 MERIDIAN E STE J107
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9604
Practice Address - Country:US
Practice Address - Phone:253-848-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60861764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist