Provider Demographics
NPI:1497774681
Name:SADIQ, ASAD SYED (DMD)
Entity Type:Individual
Prefix:DR
First Name:ASAD
Middle Name:SYED
Last Name:SADIQ
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:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08015
Mailing Address - Country:US
Mailing Address - Phone:609-893-5200
Mailing Address - Fax:609-893-7271
Practice Address - Street 1:77 JULIUSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015
Practice Address - Country:US
Practice Address - Phone:609-893-5200
Practice Address - Fax:609-893-7271
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ135401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22-3010840Medicaid