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General NPI Number Information
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NPI Number | 1588339295
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Entity Type | Individual
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Provider Name | SUHAYB MUSTAFA
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Gender | Male
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Dates
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Enumeration Date | 08/13/2021
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Last Update Date | 01/28/2023
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Provider Practice Location Address
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Address Line | 495 N SUGAR GROVE PKWY STE J
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City | SUGAR GROVE
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State | IL
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Zip | 60554-8020
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Country | US
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Telephone | 630-466-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 1950 W CERMAK RD
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City | CHICAGO
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State | IL
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Zip | 60608-4204
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019033375
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License Number State | IL
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