Healthcare Provider Details

I. General information

NPI: 1992449995
Provider Name (Legal Business Name): MADEEHA SIDDIQUI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3687 LAS POSAS RD
CAMARILLO CA
93010-1482
US

IV. Provider business mailing address

2749 ROCKY POINT CT
THOUSAND OAKS CA
91362-4943
US

V. Phone/Fax

Practice location:
  • Phone: 805-738-9500
  • Fax:
Mailing address:
  • Phone: 805-807-9912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number109975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: