Provider Demographics
NPI:1386976900
Name:ALKELIDDAR, FARRAH
Entity type:Individual
Prefix:
First Name:FARRAH
Middle Name:
Last Name:ALKELIDDAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 ELDEN ST
Mailing Address - Street 2:2C3
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4875
Mailing Address - Country:US
Mailing Address - Phone:571-441-2944
Mailing Address - Fax:
Practice Address - Street 1:171 ELDEN ST
Practice Address - Street 2:2C3
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4875
Practice Address - Country:US
Practice Address - Phone:571-441-2944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-07
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412125122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist