Provider Demographics
NPI:1881430007
Name:IFTIKHAR, FATIMA (DMD)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:IFTIKHAR
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 1:8875 STABLEHAND MEWS APT 2ND
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-1888
Mailing Address - Country:US
Mailing Address - Phone:201-981-6935
Mailing Address - Fax:
Practice Address - Street 1:1180 N PRESTON RD STE 20
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-9291
Practice Address - Country:US
Practice Address - Phone:201-981-6935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX407241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice