Provider Demographics
NPI:1629884754
Name:FATLAWI, HUDA (DDS)
Entity type:Individual
Prefix:
First Name:HUDA
Middle Name:
Last Name:FATLAWI
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 1:7942 KINGSWOOD DR APT 257
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7753
Mailing Address - Country:US
Mailing Address - Phone:916-519-7485
Mailing Address - Fax:
Practice Address - Street 1:9450 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-3588
Practice Address - Country:US
Practice Address - Phone:916-380-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1110491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice