Provider Demographics
NPI:1811506876
Name:SIDDIQUI, OSAMA MOHAMMAD (DMD)
Entity type:Individual
Prefix:DR
First Name:OSAMA
Middle Name:MOHAMMAD
Last Name:SIDDIQUI
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 1:670 W CAMPBELL RD STE 150
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3398
Mailing Address - Country:US
Mailing Address - Phone:699-427-2224
Mailing Address - Fax:469-649-0354
Practice Address - Street 1:670 W CAMPBELL RD STE 150
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3398
Practice Address - Country:US
Practice Address - Phone:469-781-0231
Practice Address - Fax:469-649-0354
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36318122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist