Provider Demographics
NPI:1053462515
Name:BILAL, MUSTAFA (DENTIST)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:BILAL
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8695 E SILVER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1654
Mailing Address - Country:US
Mailing Address - Phone:714-606-8395
Mailing Address - Fax:
Practice Address - Street 1:1210 S BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5419
Practice Address - Country:US
Practice Address - Phone:714-535-7500
Practice Address - Fax:714-535-2354
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52583OtherDENTIST