Provider Demographics
NPI:1619841640
Name:FATTUL, RAMI
Entity type:Individual
Prefix:DR
First Name:RAMI
Middle Name:
Last Name:FATTUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 MILLER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-1971
Mailing Address - Country:US
Mailing Address - Phone:817-413-6000
Mailing Address - Fax:817-977-9311
Practice Address - Street 1:3307 MILLER AVE STE A
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-1971
Practice Address - Country:US
Practice Address - Phone:817-413-6000
Practice Address - Fax:817-977-9311
Is Sole Proprietor?:No
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX419961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice