Provider Demographics
NPI:1730958273
Name:BANIMOSTAFA, LOBNA
Entity type:Individual
Prefix:
First Name:LOBNA
Middle Name:
Last Name:BANIMOSTAFA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 W OCOTILLO RD APT 600
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-8807
Mailing Address - Country:US
Mailing Address - Phone:720-462-9948
Mailing Address - Fax:
Practice Address - Street 1:1901 S SIGNAL BUTTE RD STE 107
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-2601
Practice Address - Country:US
Practice Address - Phone:480-305-0877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00205834122300000X
AZD012623122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist