Provider Demographics
NPI:1154690196
Name:MOSTAFA, SHERIN (DDS)
Entity Type:Individual
Prefix:
First Name:SHERIN
Middle Name:
Last Name:MOSTAFA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 W LINCOLN AVE STE M
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5425
Mailing Address - Country:US
Mailing Address - Phone:714-215-4252
Mailing Address - Fax:
Practice Address - Street 1:1834 W LINCOLN AVE STE M
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5425
Practice Address - Country:US
Practice Address - Phone:850-640-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS104187122300000X
FLDN19594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist