Provider Demographics
NPI:1598204265
Name:FAIQ, MARIAM (DDS)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:FAIQ
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 1:1775 GREAT NECK RD
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-2703
Mailing Address - Country:US
Mailing Address - Phone:631-238-2200
Mailing Address - Fax:
Practice Address - Street 1:1775 GREAT NECK RD
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-2703
Practice Address - Country:US
Practice Address - Phone:631-238-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist