Provider Demographics
NPI:1881413417
Name:AZFAR SIDDIQUI DMD PLLC
Entity type:Organization
Organization Name:AZFAR SIDDIQUI DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AZFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-582-9622
Mailing Address - Street 1:7012 W FIREBIRD DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9424
Mailing Address - Country:US
Mailing Address - Phone:623-225-8968
Mailing Address - Fax:
Practice Address - Street 1:16630 W GREENWAY RD STE 319
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-2189
Practice Address - Country:US
Practice Address - Phone:623-582-9622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty