Provider Demographics
NPI:1972064186
Name:FARUQI, TANIA (DDS)
Entity Type:Individual
Prefix:MISS
First Name:TANIA
Middle Name:
Last Name:FARUQI
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 1:1880 ARMSTRONG DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-6602
Mailing Address - Country:US
Mailing Address - Phone:571-426-9264
Mailing Address - Fax:
Practice Address - Street 1:1777 MADISON ST STE 100
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4912
Practice Address - Country:US
Practice Address - Phone:913-202-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN11400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program