Provider Demographics
NPI:1962419051
Name:FATTOUCH, WADID ANTOINE (DDS)
Entity type:Individual
Prefix:MR
First Name:WADID
Middle Name:ANTOINE
Last Name:FATTOUCH
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 1:11180 WARNER AV
Mailing Address - Street 2:#251
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:716-557-8492
Mailing Address - Fax:714-557-5392
Practice Address - Street 1:11180 WARNER AV
Practice Address - Street 2:#251
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:716-557-8492
Practice Address - Fax:714-557-5392
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30544122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist