Healthcare Provider Details

I. General information

NPI: 1669003844
Provider Name (Legal Business Name): MUSTAFA TATTAN DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S LINDEN RD STE D
FLINT MI
48532-5413
US

IV. Provider business mailing address

322 DENTAL SCIENCE BLDG S
IOWA CITY IA
52242
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-1311
  • Fax: 810-230-1314
Mailing address:
  • Phone: 319-335-7440
  • Fax: 319-335-7451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901601780
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: