Provider Demographics
NPI:1164675732
Name:GOCKE, FIZZAH ZAHIR (DDS)
Entity Type:Individual
Prefix:
First Name:FIZZAH
Middle Name:ZAHIR
Last Name:GOCKE
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 1:14165 ROBERT PARIS CT.
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151
Mailing Address - Country:US
Mailing Address - Phone:703-378-9600
Mailing Address - Fax:703-378-3337
Practice Address - Street 1:14165 ROBERT PARIS CT.
Practice Address - Street 2:SUITE A
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151
Practice Address - Country:US
Practice Address - Phone:703-378-9600
Practice Address - Fax:703-378-3337
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014115971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice