Individual provider Active NPI

Zahir M Siddiqui

  • General Practice Dentistry
  • Janesville, WI
National Provider Identifier
1164034245
Registry record updated Aug 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1002409 Issued in WI
Practice address
1260 Milton Ave Ste 140
Janesville, WI 53545-1890
Phone
(888) 988-4066
NPI assigned
Aug 19, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 1002409 WI Primary

Addresses

Primary practice location

1260 Milton Ave Ste 140
Janesville, WI 53545-1890

Mailing address

2050 E Algonquin Rd Ste 610
Schaumburg, IL 60173-4166
Phone (888) 988-4066

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

State licenses

LicenseStateTypeSpecialty
1002409WIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Familia Dental Janesville LLC General Practice CurrentSince Jun 27, 2021 Accepting new patients

Locations

2050 E Algonquin Rd
Ste 610
Schaumburg, IL 60173
Phone (847) 701-1457

1260 Milton Ave
Ste 140
Janesville, WI 53545
Phone (608) 757-0057

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1164034245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 E ALGONQUIN RD STE 610",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734166",
            "telephone_number": "888-988-4066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 MILTON AVE STE 140",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535451890",
            "telephone_number": "888-988-4066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "ZAHIR",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-19",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1002409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Janesville, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; 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.