Provider Demographics
NPI:1518199850
Name:HOTAIT, MUSTAPHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MUSTAPHA
Middle Name:
Last Name:HOTAIT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 VALLEY CIRCLE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3023
Mailing Address - Country:US
Mailing Address - Phone:183-486-0688
Mailing Address - Fax:
Practice Address - Street 1:1350 E SIBLEY BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-2965
Practice Address - Country:US
Practice Address - Phone:708-849-4644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist