Provider Demographics
NPI:1083965933
Name:FAHED D. HATTAR DENTAL, INC.
Entity Type:Organization
Organization Name:FAHED D. HATTAR DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-243-3595
Mailing Address - Street 1:15366 11TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3726
Mailing Address - Country:US
Mailing Address - Phone:760-243-3595
Mailing Address - Fax:760-243-3472
Practice Address - Street 1:15366 11TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3726
Practice Address - Country:US
Practice Address - Phone:760-243-3595
Practice Address - Fax:760-243-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty