Provider Demographics
NPI:1316394687
Name:TARIQ, SHAFIA
Entity Type:Individual
Prefix:
First Name:SHAFIA
Middle Name:
Last Name:TARIQ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7462 LIMESTONE DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4007
Mailing Address - Country:US
Mailing Address - Phone:703-753-3346
Mailing Address - Fax:
Practice Address - Street 1:7462 LIMESTONE DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-4007
Practice Address - Country:US
Practice Address - Phone:703-753-3346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014165261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice