Provider Demographics
NPI:1801773577
Name:FATIMA, MADIHA (DDS)
Entity type:Individual
Prefix:
First Name:MADIHA
Middle Name:
Last Name:FATIMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 CAPITAL CENTER DR APT 22
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7972
Mailing Address - Country:US
Mailing Address - Phone:916-835-8985
Mailing Address - Fax:
Practice Address - Street 1:4022 SUNRISE BLVD STE 160
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-6908
Practice Address - Country:US
Practice Address - Phone:916-246-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS112031122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist