Provider Demographics
NPI:1184279853
Name:ZAHEER, ANIQA (HO 1)
Entity type:Individual
Prefix:
First Name:ANIQA
Middle Name:
Last Name:ZAHEER
Suffix:
Gender:F
Credentials:HO 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13880 BRADDOCK RD STE 109
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2460
Mailing Address - Country:US
Mailing Address - Phone:985-590-9011
Mailing Address - Fax:
Practice Address - Street 1:13880 BRADDOCK RD STE 109
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2460
Practice Address - Country:US
Practice Address - Phone:703-830-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA04014172731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program