Provider Demographics
NPI:1942683115
Name:SIRAJ, FATIMA NAUROSE (DMD)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:NAUROSE
Last Name:SIRAJ
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 1:1230 NOCONA DRIVE,
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063
Mailing Address - Country:US
Mailing Address - Phone:847-668-2783
Mailing Address - Fax:
Practice Address - Street 1:860 EAST HIGHWAY 114 IDEAL DENTAL
Practice Address - Street 2:SUITE 200
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262
Practice Address - Country:US
Practice Address - Phone:817-491-3000
Practice Address - Fax:214-291-9582
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190302151223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice