Provider Demographics
NPI:1043669419
Name:OBAIDI, MUSTAFA (DMD)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:OBAIDI
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 1:3420 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4433
Mailing Address - Country:US
Mailing Address - Phone:815-344-0453
Mailing Address - Fax:
Practice Address - Street 1:3420 W ELM ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4433
Practice Address - Country:US
Practice Address - Phone:815-344-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030653122300000X
MI2901021942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist