Provider Demographics
NPI:1851448773
Name:BITAR, FADI (DDS)
Entity Type:Individual
Prefix:DR
First Name:FADI
Middle Name:
Last Name:BITAR
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:PO BOX 17179
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-7179
Mailing Address - Country:US
Mailing Address - Phone:949-567-3176
Mailing Address - Fax:949-567-3185
Practice Address - Street 1:1111 E TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6788
Practice Address - Country:US
Practice Address - Phone:760-327-1125
Practice Address - Fax:760-864-1593
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice