Provider Demographics
NPI:1336225713
Name:SIDDIQUI, MAMNOON AHMED (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MAMNOON
Middle Name:AHMED
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:4652 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2211
Mailing Address - Country:US
Mailing Address - Phone:734-495-3120
Mailing Address - Fax:
Practice Address - Street 1:22190 GARRISON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2260
Practice Address - Country:US
Practice Address - Phone:313-565-0880
Practice Address - Fax:313-565-2305
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010177651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics