Provider Demographics
NPI:1720135189
Name:SEDIQ, ROMAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROMAL
Middle Name:
Last Name:SEDIQ
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:PO BOX 7644
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-7002
Mailing Address - Country:US
Mailing Address - Phone:312-231-2866
Mailing Address - Fax:
Practice Address - Street 1:9352 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2810
Practice Address - Country:US
Practice Address - Phone:219-513-0555
Practice Address - Fax:219-513-0666
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190270551223G0001X
IN12010895A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice