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General NPI Number Information
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NPI Number | 1932081072
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Entity Type | Individual
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Provider Name | SUBUHI SIDDIQUI DDS
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Gender | Female
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 412 NORTHSIDE DR E
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City | STATESBORO
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State | GA
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Zip | 30458-4802
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Country | US
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Telephone | 912-225-0777
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Fax |
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Provider Business Mailing Address
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Address Line | 1881 SS RAILROAD BED RD APT 903
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City | STATESBORO
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State | GA
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Zip | 30461-8614
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Country | US
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Telephone | 213-263-1777
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Fax |
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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 | DN123924
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License Number State | GA
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