Provider Demographics
NPI:1538578984
Name:SIDDIQI, AMMAR
Entity type:Individual
Prefix:DR
First Name:AMMAR
Middle Name:
Last Name:SIDDIQI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CREEK RD STE 280
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-7700
Mailing Address - Country:US
Mailing Address - Phone:949-385-6814
Mailing Address - Fax:
Practice Address - Street 1:33 CREEK RD STE 280
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7700
Practice Address - Country:US
Practice Address - Phone:949-385-6814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6556122300000X
NV390200000X
CADDS1012171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program