Healthcare Provider Details

I. General information

NPI: 1891620407
Provider Name (Legal Business Name): ALFRED MUSTAFA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 S GAREY AVE
POMONA CA
91766-5645
US

IV. Provider business mailing address

5259 MONET CT
CHINO HILLS CA
91709-6129
US

V. Phone/Fax

Practice location:
  • Phone: 909-364-0633
  • Fax:
Mailing address:
  • Phone: 909-614-9171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: