Organization Name: | MUSTAPHA HOTAIT DDS PC |
NPI Number: | 1306267265 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MUSTAPHA HOTAIT (PRESIDENT) |
Mailing Address: | 1350 E Sibley Blvd Suite 302 Dolton |
State: | IL US |
Postal Code: | 604192965 |
Phone Number: | 3139998889 |
Fax Number: | |
NPI Enumeration Date: | 12/19/2013 |
NPI Last Update Date: | 12/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |