Provider Demographics
NPI:1114277191
Name:FAROOQ, AYESHA (DDS)
Entity Type:Individual
Prefix:
First Name:AYESHA
Middle Name:
Last Name:FAROOQ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6809
Mailing Address - Country:US
Mailing Address - Phone:513-593-0190
Mailing Address - Fax:
Practice Address - Street 1:14 MACDAVE BLVD
Practice Address - Street 2:GENTLE DENTAL
Practice Address - City:COLLINGDALE
Practice Address - State:PA
Practice Address - Zip Code:19023
Practice Address - Country:US
Practice Address - Phone:513-593-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039345122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program