Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 7441 | OK |
NPI | 1003482589 |
---|---|
Provider Name | Dr. Siddharth Verma |
First Address | Oklahoma City, OK 73105-1728 |
Second Address | Oklahoma City, OK 73110-2821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2021 |
Last Update Date | 03/06/2021 |