MEDICARE: FAIQ DENTISTRY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043942337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIQ DENTISTRY PC

Provider Business Mailing Address
First Line	:	1775 GREAT NECK RD UNIT C
Second Line	:
City	:	COPIAGUE
State	:	NY
Zip	:	11726-2703
Country	:	US
Telephone Number	:	631-238-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 GREAT NECK RD UNIT C
Second Line	:
City	:	COPIAGUE
State	:	NY
Zip	:	11726-2703
Country	:	US
Telephone Number	:	631-238-2200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIAM FAIQ
Credential	:	DDS
Telephone Number	:	631-238-2200

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/27/2022

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Directions to “FAIQ DENTISTRY PC ” Practice Location

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