Provider Demographics
NPI:1306807722
Name:SIDDIQUI, AZFAR AFTAB (DMD,MSC)
Entity type:Individual
Prefix:DR
First Name:AZFAR
Middle Name:AFTAB
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:DMD,MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16630 W GREENWAY RD STE 319
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-2189
Mailing Address - Country:US
Mailing Address - Phone:623-582-9622
Mailing Address - Fax:623-537-5430
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:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 031537-L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics