Healthcare Provider Details

I. General information

NPI: 1376053595
Provider Name (Legal Business Name): MUSTAFA ALANI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9310 OLD KINGS RD S STE 601
JACKSONVILLE FL
32257-6178
US

IV. Provider business mailing address

9310 OLD KINGS RD S STE 601
JACKSONVILLE FL
32257-6178
US

V. Phone/Fax

Practice location:
  • Phone: 904-442-1944
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN22992
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN22992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: