Provider Demographics
NPI:1568635480
Name:TARIQ, SANAA SHAMAIL (DMD)
Entity type:Individual
Prefix:DR
First Name:SANAA
Middle Name:SHAMAIL
Last Name:TARIQ
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 1:9 MACARTHUR PL UNIT 509
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-6741
Mailing Address - Country:US
Mailing Address - Phone:954-881-0357
Mailing Address - Fax:
Practice Address - Street 1:9 MACARTHUR PL UNIT 509
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-6741
Practice Address - Country:US
Practice Address - Phone:954-881-0357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 17977122300000X
TX24452122300000X
CA61038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist