Individual provider Active NPI

Rajeev Rugi Siddappa, BDS,MS

  • General Practice Dentistry
  • Spokane, WA
National Provider Identifier
1063074250
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE61437579 Issued in WA
Practice address
9405 N Newport Hwy
Spokane, WA 99218-1390
Phone
(866) 803-4943
NPI assigned
Jul 8, 2019
Last updated
Apr 3, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Denturist 122400000X 10195475 OR
General Practice Dentistry 1223G0001X DE61437579 WA Primary

Addresses

Primary practice location

9405 N Newport Hwy
Spokane, WA 99218-1390

Mailing address

9405 N Newport Hwy
Spokane, WA 99218-1390

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
DE61437579WAMDGeneral Practice Dentistry
10195475ORMDDenturist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743638400000",
    "number": "1063074250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9405 N NEWPORT HWY",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992181390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9405 N NEWPORT HWY",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992181390",
            "telephone_number": "866-803-4943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUGI SIDDAPPA",
        "first_name": "RAJEEV",
        "name_prefix": "Dr.",
        "credential": "BDS,MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-08",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122400000X",
            "taxonomy_group": "",
            "desc": "Denturist",
            "state": "OR",
            "license": "10195475",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE61437579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.