Provider Demographics
NPI:1477718369
Name:IQBAL, SIDDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:SIDDRA
Middle Name:
Last Name:IQBAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7260 W LAKE MEAD BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8357
Mailing Address - Country:US
Mailing Address - Phone:734-931-2012
Mailing Address - Fax:702-562-8868
Practice Address - Street 1:7260 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8357
Practice Address - Country:US
Practice Address - Phone:734-931-2012
Practice Address - Fax:702-562-8868
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV61751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice