Provider Demographics
NPI:1508637232
Name:ALAM, PUSPA FATIMA (DMD)
Entity Type:Individual
Prefix:
First Name:PUSPA
Middle Name:FATIMA
Last Name:ALAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 BANTRY CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3170
Mailing Address - Country:US
Mailing Address - Phone:917-412-3334
Mailing Address - Fax:
Practice Address - Street 1:5419 BANTRY CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-3170
Practice Address - Country:US
Practice Address - Phone:917-412-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401418719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist