=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669354148
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIDDAPPA DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2025
-----------------------------------------------------
Last Update Date | 10/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28348 ROADSIDE DR STE 201
-----------------------------------------------------
City | AGOURA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91301-2596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-208-1502
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 372 CAMINO DE CELESTE
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91360-7124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-208-1502
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SAVITHA SIDDAPPA
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 805-208-1502
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X2210X
-----------------------------------------------------
Taxonomy Name | Orofacial Pain Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------