Healthcare Provider Details

I. General information

NPI: 1306807722
Provider Name (Legal Business Name): AZFAR AFTAB SIDDIQUI DMD.,MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16630 W GREENWAY RD STE 319
SURPRISE AZ
85388-2189
US

IV. Provider business mailing address

16630 W GREENWAY RD STE 319
SURPRISE AZ
85388-2189
US

V. Phone/Fax

Practice location:
  • Phone: 623-582-9622
  • Fax:
Mailing address:
  • Phone: 623-582-9622
  • Fax: 623-537-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS 031537-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: