Provider Demographics
NPI:1518752682
Name:ABUMUSTAFA, AHMED
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:ABUMUSTAFA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 NIAZUMA AVE S APT F
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2557
Mailing Address - Country:US
Mailing Address - Phone:510-634-6868
Mailing Address - Fax:
Practice Address - Street 1:510 S JEFFERSON AVE STE 102
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4010
Practice Address - Country:US
Practice Address - Phone:931-854-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX412591223X0400X
TN127761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics