Whalio Doctors

NPI 1093780603

Tirbod Todd Fattahi, MDDDS

Practitioner Oral & Maxillofacial Surgery (D.M.D.) Jacksonville, FL

Practice location

Address
655 W 8th St Ufjp Oral Surgery, Jacksonville, FL 32209-6511
Phone
(904) 244-3901
Fax
(904) 244-3218
Mailing address
PO Box 44008 Ufjp Provider Enrollment, Jacksonville, FL 32231-4008

Registered specialties (2)

Oral & Maxillofacial Surgery (D.M.D.) Primary
Allopathic & Osteopathic Physicians Taxonomy 204E00000X Licence ME85119 (FL)
Dentist
Dental Providers Taxonomy 122300000X Licence DTP368 (FL)

Registry record

NPI
1093780603
Entity type
Individual
Sex (as registered)
Male
NPI issued
18 Feb 2006
Record last updated
29 Apr 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.