Provider Demographics
NPI:1487126959
Name:FAISAL, HIRA
Entity type:Individual
Prefix:
First Name:HIRA
Middle Name:
Last Name:FAISAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 N AIRMONT RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4242
Mailing Address - Country:US
Mailing Address - Phone:845-512-1219
Mailing Address - Fax:
Practice Address - Street 1:29 N AIRMONT RD # 2
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4242
Practice Address - Country:US
Practice Address - Phone:845-512-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858737122300000X
NY061135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist