Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 019-027754 | IL |
N | 1223S0112X | Oral and Maxillofacial Surgeon | OMS 101 | CA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | A122601 | CA |
NPI | 1407036502 |
---|---|
Provider Name | Dr. Tarkan Sidal |
First Address | San Diego, CA 92123-4205 |
Second Address | San Diego, CA 92123-4205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2007 |
Last Update Date | 21/07/2014 |