Provider Demographics
NPI:1720658073
Name:AL-FATLAWI, YASSAR (DMD)
Entity type:Individual
Prefix:DR
First Name:YASSAR
Middle Name:
Last Name:AL-FATLAWI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 N HOLIDAY RD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-6936
Mailing Address - Country:US
Mailing Address - Phone:850-213-2626
Mailing Address - Fax:
Practice Address - Street 1:66 N HOLIDAY RD
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-6936
Practice Address - Country:US
Practice Address - Phone:850-213-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN260831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice