Provider Demographics
NPI:1356469944
Name:ISKAQ, TAUFIK FARADY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAUFIK
Middle Name:FARADY
Last Name:ISKAQ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 N. CENTRAL AVE.,
Mailing Address - Street 2:SUITE A
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4219
Mailing Address - Country:US
Mailing Address - Phone:909-931-2600
Mailing Address - Fax:909-931-2605
Practice Address - Street 1:495 N. CENTRAL AVE.,
Practice Address - Street 2:SUITE A
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4219
Practice Address - Country:US
Practice Address - Phone:909-931-2600
Practice Address - Fax:909-931-2605
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice