Provider Demographics
NPI:1740929561
Name:SIDDIQI, ASAD AFTAB
Entity type:Individual
Prefix:
First Name:ASAD
Middle Name:AFTAB
Last Name:SIDDIQI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 N WESLEYAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1786
Mailing Address - Country:US
Mailing Address - Phone:252-316-3138
Mailing Address - Fax:
Practice Address - Street 1:955 N WESLEYAN BLVD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1786
Practice Address - Country:US
Practice Address - Phone:252-316-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC134151223G0001X
OHRES.004467122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist