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General NPI Number Information
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NPI Number | 1144386194
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Entity Type | Individual
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Provider Name | ROBERT W FATTOUCH DMD
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 15835 POMERADO RD STE 303
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City | POWAY
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State | CA
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Zip | 92064-2043
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Country | US
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Telephone | 858-674-4261
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Fax |
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Provider Business Mailing Address
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Address Line | 15835 POMERADO RD SUITE 303
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City | POWAY
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State | CA
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Zip | 92064-2073
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Country | US
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Telephone | 858-674-4261
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Fax | 858-676-0258
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D5481
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 60280
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License Number State | CA
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