Provider Demographics
NPI:1619243227
Name:ROBERT W. FATTOUCH D.M.D., P.C.
Entity Type:Organization
Organization Name:ROBERT W. FATTOUCH D.M.D., P.C.
Other - Org Name:POWAY PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WADID
Authorized Official - Last Name:FATTOUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-674-4261
Mailing Address - Street 1:15835 POMERADO RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2073
Mailing Address - Country:US
Mailing Address - Phone:868-674-4261
Mailing Address - Fax:858-676-0258
Practice Address - Street 1:15835 POMERADO RD.
Practice Address - Street 2:SUITE 303
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2073
Practice Address - Country:US
Practice Address - Phone:858-674-4267
Practice Address - Fax:858-676-0258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA602801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty