Provider Demographics
NPI:1023501673
Name:JINDAL, SIDDHI SHAH (DMD)
Entity type:Individual
Prefix:
First Name:SIDDHI
Middle Name:SHAH
Last Name:JINDAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CORPORATE PARK DR APT 3103
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3336
Mailing Address - Country:US
Mailing Address - Phone:973-510-5881
Mailing Address - Fax:
Practice Address - Street 1:180 E POST RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4910
Practice Address - Country:US
Practice Address - Phone:973-510-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA8953122300000X
NY062326-011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist