Healthcare Provider Details

I. General information

NPI: 1003741653
Provider Name (Legal Business Name): YASIN SIDDIQUEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5630 N TOWER RD
DENVER CO
80249-8019
US

IV. Provider business mailing address

1731 STRATFORD XING SE
CONYERS GA
30013-6432
US

V. Phone/Fax

Practice location:
  • Phone: 720-259-6154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00206695
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: