Provider Demographics
NPI:1790831212
Name:FATOUH, SOLAFA SEDKI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOLAFA
Middle Name:SEDKI
Last Name:FATOUH
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 1:1537 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-2908
Mailing Address - Country:US
Mailing Address - Phone:718-617-0624
Mailing Address - Fax:718-328-3887
Practice Address - Street 1:1537 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-2908
Practice Address - Country:US
Practice Address - Phone:718-617-0624
Practice Address - Fax:718-328-3887
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0413101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01087961Medicaid