Provider Demographics
NPI:1407581705
Name:AL BAYATY, MUSTAFA (DMD)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:AL BAYATY
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 1:21040 HIGHLAND KNOLLS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1581
Mailing Address - Country:US
Mailing Address - Phone:713-966-6333
Mailing Address - Fax:
Practice Address - Street 1:21040 HIGHLAND KNOLLS DR STE 100
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1581
Practice Address - Country:US
Practice Address - Phone:713-966-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX386881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice