Provider Demographics
NPI:1912380270
Name:ALIAJ, FATBARDHA (DMD)
Entity Type:Individual
Prefix:
First Name:FATBARDHA
Middle Name:
Last Name:ALIAJ
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 1:1015 THRUSH LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-2027
Mailing Address - Country:US
Mailing Address - Phone:267-671-7380
Mailing Address - Fax:
Practice Address - Street 1:3300 RYAN AVE
Practice Address - Street 2:STE A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-4320
Practice Address - Country:US
Practice Address - Phone:215-333-2212
Practice Address - Fax:215-333-2240
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist