Provider Demographics
NPI:1619717527
Name:MOSTAFA, AHMED (DMD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:MOSTAFA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FERNWAY CIR
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-3424
Mailing Address - Country:US
Mailing Address - Phone:551-234-1062
Mailing Address - Fax:
Practice Address - Street 1:473 YORK RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-4517
Practice Address - Country:US
Practice Address - Phone:215-672-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0446121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice