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General NPI Number Information
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NPI Number | 1700319035
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Entity Type | Individual
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Provider Name | KAAENAAT MUSTAFA
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Gender | Female
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 2301 E ALLEGHENY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19134-4427
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Country | US
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Telephone | 919-802-2148
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Fax |
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Provider Business Mailing Address
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Address Line | 228 BILLINGRATH TURN LN
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City | CARY
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State | NC
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Zip | 27519-2908
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Country | US
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Telephone | 919-802-2148
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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 | DS043566
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 10915
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10915
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 10915
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License Number State | NC
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