Provider Demographics
NPI:1407395064
Name:AL MUSTAFA, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:AL MUSTAFA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17802 MOUND RD
Mailing Address - Street 2:APT 23106
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-0062
Mailing Address - Country:US
Mailing Address - Phone:713-628-7583
Mailing Address - Fax:
Practice Address - Street 1:28602 TOMBALL PKWY
Practice Address - Street 2:STE B
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4204
Practice Address - Country:US
Practice Address - Phone:281-256-7554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist