Provider Demographics
NPI:1386421311
Name:HAMAD, MUSTAFA
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:HAMAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 W PUENTE ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-3790
Mailing Address - Country:US
Mailing Address - Phone:323-899-2039
Mailing Address - Fax:
Practice Address - Street 1:3318 NILES ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4424
Practice Address - Country:US
Practice Address - Phone:661-469-1484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1093721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice