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15835 Pomerado Rd. Suite 303 Poway CA 92064-2073 | |
| (858) 674-4267 | |
| (858) 676-0258 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 15835 Pomerado Rd., Poway, California |
| Authorized Official Name and Position | Robert Wadid Fattouch (OWNER/PRESIDENT) |
| Authorized Official Contact | 8586744261 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
15835 Pomerado Rd Suite 303 Poway CA 92064-2073 Ph: (868) 674-4261 | 15835 Pomerado Rd. Suite 303 Poway CA 92064-2073 Ph: (858) 674-4267 |
| NPI Number | 1619243227 |
|---|---|
| Provider Enumeration Date | 03/28/2012 |
| Last Update Date | 03/28/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619243227 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 60280 (California) | Primary |
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