MEDICARE: DR. SIDDHI JYOTINDRA DOSHI D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	6361-015	WI

General Provider Information

NPI Number	:	1366676611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIDDHI JYOTINDRA DOSHI D.D.S., M.S.

Provider Business Mailing Address
First Line	:	692 N MIDVALE BLVD
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-3200
Country	:	US
Telephone Number	:	847-800-7433
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WILBURN RD
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-1478
Country	:	US
Telephone Number	:	847-800-7433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2009
Last Update Date	:	05/14/2009

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