Healthcare Provider Details

I. General information

NPI: 1659985802
Provider Name (Legal Business Name): RW FATTOUCH DMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42210 LYNDIE LN STE 100
TEMECULA CA
92591-3604
US

IV. Provider business mailing address

42210 LYNDIE LN STE 100
TEMECULA CA
92591-3604
US

V. Phone/Fax

Practice location:
  • Phone: 951-506-1666
  • Fax: 888-932-5863
Mailing address:
  • Phone: 951-506-1666
  • Fax: 888-932-5863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT WADID FATTOUCH
Title or Position: OWNER
Credential: DMD
Phone: 951-506-1666