Provider Demographics
NPI:1881849149
Name:FIRDOSE, FATHIMA H
Entity Type:Individual
Prefix:DR
First Name:FATHIMA
Middle Name:H
Last Name:FIRDOSE
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 1:1574 ONYX DR
Mailing Address - Street 2:UNIT 105
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3958
Mailing Address - Country:US
Mailing Address - Phone:443-850-9354
Mailing Address - Fax:
Practice Address - Street 1:1574 ONYX DR
Practice Address - Street 2:UNIT 105
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3958
Practice Address - Country:US
Practice Address - Phone:443-850-9354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-28
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412333122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist