Provider Demographics
NPI:1386117893
Name:WARRIACH, FAHAD IKRAM (DDS)
Entity type:Individual
Prefix:DR
First Name:FAHAD
Middle Name:IKRAM
Last Name:WARRIACH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 E NEES AVE APT 257
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-6022
Mailing Address - Country:US
Mailing Address - Phone:718-795-3892
Mailing Address - Fax:
Practice Address - Street 1:285 W EL MONTE WAY
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-1555
Practice Address - Country:US
Practice Address - Phone:155-930-2914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103424122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist