Provider Demographics
NPI:1740542927
Name:HAFIDH, IFRAJ FUAD (DDS)
Entity type:Individual
Prefix:DR
First Name:IFRAJ
Middle Name:FUAD
Last Name:HAFIDH
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 1:74 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1548
Mailing Address - Country:US
Mailing Address - Phone:518-439-3299
Mailing Address - Fax:
Practice Address - Street 1:74 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1548
Practice Address - Country:US
Practice Address - Phone:518-439-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0572351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice