Healthcare Provider Details

I. General information

NPI: 1518199850
Provider Name (Legal Business Name): MUSTAPHA HOTAIT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E SIBLEY BLVD SUITE 302
DOLTON IL
60419-2965
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 708-849-4644
  • Fax:
Mailing address:
  • Phone: 183-486-0688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019028015
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: