Provider Demographics
NPI:1063086296
Name:ALWAN, MUSTAFA (DDS)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:ALWAN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 JOHNSTOWN DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-8114
Mailing Address - Country:US
Mailing Address - Phone:615-768-1573
Mailing Address - Fax:
Practice Address - Street 1:7041 HWY 70 S # 7
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-5238
Practice Address - Country:US
Practice Address - Phone:615-662-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN115401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice