Healthcare Provider Details

I. General information

NPI: 1366163586
Provider Name (Legal Business Name): DANIAH TIKREETI BDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 PARK HILL DR STE A
FREDERICKSBURG VA
22401-3357
US

IV. Provider business mailing address

121 PARK HILL DR STE A
FREDERICKSBURG VA
22401-3357
US

V. Phone/Fax

Practice location:
  • Phone: 540-373-1660
  • Fax:
Mailing address:
  • Phone: 540-373-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401418086
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: