Individual
MIR AYESHA SIDDIQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
311 DORIC AVE, CRANSTON, RI 02910-2903
(401) 562-8303
Mailing address
311 DORIC AVE, 311 DORIC AVENUE, CRANSTON, RI 02910-2903
(401) 562-8303
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8198
SC
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
8198
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/22/2012
Last updated
10/22/2015
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