Healthcare Provider Details

I. General information

NPI: 1134051378
Provider Name (Legal Business Name): RAKAN ADNAN MUQATASH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N GREENFIELD RD STE 2
MESA AZ
85205-7802
US

IV. Provider business mailing address

2084 DONOVAN DR
LINCOLN CA
95648-2966
US

V. Phone/Fax

Practice location:
  • Phone: 480-832-5190
  • Fax:
Mailing address:
  • Phone: 916-884-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012832
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: