Provider Demographics
NPI:1154876035
Name:SIDDIQUI, ABUZAR ARSHI (BDS,MPH)
Entity type:Individual
Prefix:DR
First Name:ABUZAR
Middle Name:ARSHI
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:BDS,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1314
Mailing Address - Country:US
Mailing Address - Phone:781-581-3900
Mailing Address - Fax:
Practice Address - Street 1:112 W HOUSE ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-2811
Practice Address - Country:US
Practice Address - Phone:281-968-7048
Practice Address - Fax:832-514-3630
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX346451223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX39609401Medicaid