Provider Demographics
NPI:1598861924
Name:FATOUREHCHIAN, ARA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARA
Middle Name:
Last Name:FATOUREHCHIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 CEDAR SPRINGS RD
Mailing Address - Street 2:UNIT #1106
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4136
Mailing Address - Country:US
Mailing Address - Phone:949-922-0444
Mailing Address - Fax:
Practice Address - Street 1:305 E CAMP WISDOM RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-2705
Practice Address - Country:US
Practice Address - Phone:972-296-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546951223G0001X
TX292961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice