Provider Demographics
NPI:1750270765
Name:SIDDIQUE, BEENISH (DMD)
Entity type:Individual
Prefix:DR
First Name:BEENISH
Middle Name:
Last Name:SIDDIQUE
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 1:709 AMELIA ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20861-4123
Mailing Address - Country:US
Mailing Address - Phone:301-655-1591
Mailing Address - Fax:
Practice Address - Street 1:709 AMELIA ISLAND CT
Practice Address - Street 2:
Practice Address - City:ASHTON
Practice Address - State:MD
Practice Address - Zip Code:20861-4123
Practice Address - Country:US
Practice Address - Phone:301-655-1591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD188171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice