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General NPI Number Information
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NPI Number | 1942683115
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Entity Type | Individual
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Provider Name | FATIMA NAUROSE SIRAJ D.M.D
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Gender | Female
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 12/19/2018
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Provider Practice Location Address
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Address Line | 860 EAST HIGHWAY 114 IDEAL DENTAL SUITE 200
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City | ROANOKE
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State | TX
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Zip | 76262
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Country | US
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Telephone | 817-491-3000
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Fax | 214-291-9582
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Provider Business Mailing Address
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Address Line | 1230 NOCONA DRIVE,
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City | IRVING
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State | TX
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Zip | 75063
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Country | US
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Telephone | 847-668-2783
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019030215
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019030215
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License Number State | IL
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