Healthcare Provider Details

I. General information

NPI: 1619098480
Provider Name (Legal Business Name): JOHN CHRISTOPHER FAT D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 S LAND PARK DR SUITE A
SACRAMENTO CA
95831-3663
US

IV. Provider business mailing address

7210 S LAND PARK DR SUITE A
SACRAMENTO CA
95831-3663
US

V. Phone/Fax

Practice location:
  • Phone: 916-427-2555
  • Fax: 916-395-2164
Mailing address:
  • Phone: 916-427-2555
  • Fax: 916-395-2164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number153371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: