Provider Demographics
NPI:1649955162
Name:SIDDIQUI, ANUM (DDS)
Entity type:Individual
Prefix:
First Name:ANUM
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 JENNA CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6406
Mailing Address - Country:US
Mailing Address - Phone:920-791-9243
Mailing Address - Fax:
Practice Address - Street 1:1301 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-5013
Practice Address - Country:US
Practice Address - Phone:630-882-3426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0343561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice