Provider Demographics
NPI:1760259303
Name:MUSTAFA MAKATI DDS A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:MUSTAFA MAKATI DDS A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:AHMEDALI
Authorized Official - Last Name:MAKATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-289-7886
Mailing Address - Street 1:2205 VESPER CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3501
Mailing Address - Country:US
Mailing Address - Phone:951-737-5540
Mailing Address - Fax:909-881-2670
Practice Address - Street 1:2205 VESPER CIR STE 103
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3501
Practice Address - Country:US
Practice Address - Phone:951-737-5540
Practice Address - Fax:909-881-2670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty