Individual
AMINE FATTAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
23618 US HIGHWAY 33, ELKHART, IN 46517-3608
(574) 875-8196
Mailing address
23618 US HIGHWAY 33, ELKHART, IN 46517-3608
(574) 875-8196
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12014217A
IN
Other
Enumeration date
07/23/2021
Last updated
09/21/2023
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