Provider Demographics
NPI:1043942337
Name:FAIQ DENTISTRY PC
Entity Type:Organization
Organization Name:FAIQ DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIQ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-238-2200
Mailing Address - Street 1:1775 GREAT NECK RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-2703
Mailing Address - Country:US
Mailing Address - Phone:631-238-2200
Mailing Address - Fax:
Practice Address - Street 1:1775 GREAT NECK RD UNIT C
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-2703
Practice Address - Country:US
Practice Address - Phone:631-238-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05501560Medicaid