Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0401416205 | VA |
NPI | 1073071197 |
---|---|
Provider Name | Dr. Shaden Alfaqih |
First Address | Alexandria, VA 22314 |
Second Address | Washington, DC 20059-5904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2019 |
Last Update Date | 27/07/2020 |