Provider Demographics
NPI:1356870513
Name:IQBAL, MUSTAFA (DDS)
Entity type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:
Last Name:IQBAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12904 GORDONS HVN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6402
Mailing Address - Country:US
Mailing Address - Phone:210-215-9663
Mailing Address - Fax:
Practice Address - Street 1:1925 PARK LAKE DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-1682
Practice Address - Country:US
Practice Address - Phone:254-221-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice