Provider Demographics
NPI:1841553302
Name:MUSTAFA, LENA (DDS)
Entity type:Individual
Prefix:DR
First Name:LENA
Middle Name:
Last Name:MUSTAFA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27329 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-5200
Mailing Address - Country:US
Mailing Address - Phone:313-655-8773
Mailing Address - Fax:
Practice Address - Street 1:27329 WILSON DR
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-5200
Practice Address - Country:US
Practice Address - Phone:313-655-8773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist