Provider Demographics
NPI:1154619120
Name:SIDDIQI, AHMED HUSAIN (DDS)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:HUSAIN
Last Name:SIDDIQI
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 1:12108 FOREST SAGE LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4573
Mailing Address - Country:US
Mailing Address - Phone:713-340-0394
Mailing Address - Fax:
Practice Address - Street 1:12100 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-6908
Practice Address - Country:US
Practice Address - Phone:732-668-9275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX265571223G0001X
VA04014172401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26557Medicaid