Provider Demographics
NPI:1669354148
Name:SIDDAPPA DENTAL CORPORATION
Entity type:Organization
Organization Name:SIDDAPPA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAVITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:805-208-1502
Mailing Address - Street 1:372 CAMINO DE CELESTE
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-7124
Mailing Address - Country:US
Mailing Address - Phone:805-208-1502
Mailing Address - Fax:
Practice Address - Street 1:28348 ROADSIDE DR STE 201
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2596
Practice Address - Country:US
Practice Address - Phone:805-208-1502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Single Specialty