Provider Demographics
NPI:1982796934
Name:MOSTOVOY, ROBERT JACK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JACK
Last Name:MOSTOVOY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3641 SACRAMENTO ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1722
Mailing Address - Country:US
Mailing Address - Phone:415-775-0974
Mailing Address - Fax:415-775-2408
Practice Address - Street 1:3641 SACRAMENTO ST
Practice Address - Street 2:SUITE H
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1722
Practice Address - Country:US
Practice Address - Phone:415-775-0974
Practice Address - Fax:415-775-2408
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA196511223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics