Healthcare Provider Details

I. General information

NPI: 1770245870
Provider Name (Legal Business Name): HOTAIT DENTAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 VALLEY CIRCLE BLVD STE B
WEST HILLS CA
91304-3023
US

IV. Provider business mailing address

8300 VALLEY CIRCLE BLVD STE B
WEST HILLS CA
91304-3023
US

V. Phone/Fax

Practice location:
  • Phone: 818-348-6068
  • Fax:
Mailing address:
  • Phone: 818-348-6068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MUSTAPHA HOTAIT
Title or Position: DOCTOR/OWNER
Credential: DDS
Phone: 818-348-6068