Provider Demographics
NPI:1750536538
Name:SEDDIKI, OTHMANE (DDS)
Entity type:Individual
Prefix:DR
First Name:OTHMANE
Middle Name:
Last Name:SEDDIKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 MOUNT PROSPECT AVE
Mailing Address - Street 2:STE B
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-3109
Mailing Address - Country:US
Mailing Address - Phone:973-600-7528
Mailing Address - Fax:
Practice Address - Street 1:671 MOUNT PROSPECT AVE
Practice Address - Street 2:STE B
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3109
Practice Address - Country:US
Practice Address - Phone:973-600-7528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023862001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice