Provider Demographics
NPI:1689976540
Name:MUSTAPHA HOTAIT DDS PC
Entity Type:Organization
Organization Name:MUSTAPHA HOTAIT DDS PC
Other - Org Name:DOLTON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAPHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOTAIT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-849-4644
Mailing Address - Street 1:1350 E SIBLEY BLVD
Mailing Address - Street 2:STE 302
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-2965
Mailing Address - Country:US
Mailing Address - Phone:708-849-4644
Mailing Address - Fax:708-849-4735
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:708-849-4735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190281051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty