Provider Demographics
NPI:1013035260
Name:KATTAR, FADI (DDS)
Entity Type:Individual
Prefix:DR
First Name:FADI
Middle Name:
Last Name:KATTAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N ALMANSOR ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-2622
Mailing Address - Country:US
Mailing Address - Phone:626-222-0018
Mailing Address - Fax:
Practice Address - Street 1:8540 S SEPULVEDA BLVD STE 1210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3819
Practice Address - Country:US
Practice Address - Phone:424-253-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA510851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD51085OtherDENTI-CAL