Healthcare Provider Details

I. General information

NPI: 1841925419
Provider Name (Legal Business Name): DARAKSHAN FATMI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3728 CRAIN HWY UNIT 105
WALDORF MD
20603-4888
US

IV. Provider business mailing address

1716 M ST NE
WASHINGTON DC
20002-2008
US

V. Phone/Fax

Practice location:
  • Phone: 240-448-2634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17794
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN2000147
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: