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FATHALLAH MOHAMED FATHALLAH GHATTAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
18070 S TAMIAMI TRL, FORT MYERS, FL 33908-4602
(216) 583-6545
Mailing address
656 SHADOWMOSS CIR, LAKE MARY, FL 32746-4421
(216) 583-6545

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
RES.004133
OH
1223G0001X
General Practice Dentistry
26245
FL
1223G0001X
General Practice Dentistry
Primary
DN26245
FL

Other

Enumeration date
06/28/2019
Last updated
04/14/2023
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