Provider Demographics
NPI:1376928275
Name:MOSTAFIZ, WHITNEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:
Last Name:MOSTAFIZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 RAYMOND PL
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-2309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:445 5TH AVE
Practice Address - Street 2:APT 15B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0133
Practice Address - Country:US
Practice Address - Phone:516-765-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist