Provider Demographics
NPI:1689737512
Name:SIDDAPPA, SAVITHA (DMD)
Entity Type:Individual
Prefix:
First Name:SAVITHA
Middle Name:
Last Name:SIDDAPPA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 SUNSET KNOLLS DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4823
Mailing Address - Country:US
Mailing Address - Phone:805-380-4222
Mailing Address - Fax:
Practice Address - Street 1:355 E. AVENIDA DE LOS ARBOLES
Practice Address - Street 2:SUITE A
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-241-5353
Practice Address - Fax:805-241-1515
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56598122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist