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General NPI Number Information
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NPI Number | 1811506876
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Entity Type | Individual
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Provider Name | OSAMA MOHAMMAD SIDDIQUI DMD
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Gender | Male
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 670 W CAMPBELL RD STE 150
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City | RICHARDSON
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State | TX
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Zip | 75080-3398
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Country | US
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Telephone | 469-781-0231
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Fax | 469-649-0354
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Provider Business Mailing Address
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Address Line | 670 W CAMPBELL RD STE 150
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City | RICHARDSON
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State | TX
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Zip | 75080-3398
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Country | US
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Telephone | 699-427-2224
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Fax | 469-649-0354
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 36318
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 36318
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License Number State | TX
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