Provider Demographics
NPI:1518309145
Name:SIDDIQUI, RASHEED (DMD)
Entity Type:Individual
Prefix:
First Name:RASHEED
Middle Name:
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 1:125 BAKER ST UNIT 433
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4592
Mailing Address - Country:US
Mailing Address - Phone:918-638-1407
Mailing Address - Fax:
Practice Address - Street 1:4950 BARRANCA PKWY STE 105
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4630
Practice Address - Country:US
Practice Address - Phone:949-551-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 202931223G0001X
CADDS1032991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice