Provider Demographics
NPI:1982375713
Name:AL-YAFFAI, FATIMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:
Last Name:AL-YAFFAI
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 1:1290 NOSTRAND AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1533
Mailing Address - Country:US
Mailing Address - Phone:347-278-0487
Mailing Address - Fax:
Practice Address - Street 1:3043 JOHN F KENNEDY BLVD FL 1
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3605
Practice Address - Country:US
Practice Address - Phone:201-484-5483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-12-18
Deactivation Date:2021-11-19
Deactivation Code:
Reactivation Date:2021-12-17
Provider Licenses
StateLicense IDTaxonomies
CT13250122300000X
NJ22DI02866900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist