Provider Demographics
NPI:1396351318
Name:ALWAKEEL, MOSTAFA (DMD)
Entity type:Individual
Prefix:
First Name:MOSTAFA
Middle Name:
Last Name:ALWAKEEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 WISSAHICKON AVE APT B232
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-5404
Mailing Address - Country:US
Mailing Address - Phone:202-830-8604
Mailing Address - Fax:
Practice Address - Street 1:5450 WISSAHICKON AVE APT B232
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-5404
Practice Address - Country:US
Practice Address - Phone:202-830-8604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist