Healthcare Provider Details

I. General information

NPI: 1083157549
Provider Name (Legal Business Name): AHMAD MOKBIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 WALERGA RD
ANTELOPE CA
95843-9001
US

IV. Provider business mailing address

5215 W BANFF LN
GLENDALE AZ
85306-3915
US

V. Phone/Fax

Practice location:
  • Phone: 602-303-1062
  • Fax:
Mailing address:
  • Phone: 602-303-1062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number139962939926
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10557
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number101058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: