Provider Demographics
NPI:1669511986
Name:MAKATI, MUSTAFA AHMEDALI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:AHMEDALI
Last Name:MAKATI
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 1:1063 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-3207
Mailing Address - Country:US
Mailing Address - Phone:909-881-2679
Mailing Address - Fax:909-881-2670
Practice Address - Street 1:1063 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-3207
Practice Address - Country:US
Practice Address - Phone:909-881-2679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice