Healthcare Provider Details

I. General information

NPI: 1063074250
Provider Name (Legal Business Name): RAJEEV RUGI SIDDAPPA BDS,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9405 N NEWPORT HWY
SPOKANE WA
99218-1390
US

IV. Provider business mailing address

9405 N NEWPORT HWY
SPOKANE WA
99218-1390
US

V. Phone/Fax

Practice location:
  • Phone: 866-803-4943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122400000X
TaxonomyDenturist
License Number10195475
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE61437579
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: