MEDICARE: MOSTAFA TABAA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	30026606	OH

General Provider Information

NPI Number	:	1649766593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOSTAFA TABAA DDS

Provider Business Mailing Address
First Line	:	5850 BOYMEL DR STE 2
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-5500
Country	:	US
Telephone Number	:	513-856-8252
Fax Number	:

Provider Business Practice Location Address
First Line	:	5850 BOYMEL DR STE 2
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-5500
Country	:	US
Telephone Number	:	513-856-8252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2018
Last Update Date	:	02/25/2026

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