Individual provider Active NPI

Mostafa Alwakeel, DMD

  • Dentist
  • Philadelphia, PA
National Provider Identifier
1396351318
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DS042837 Issued in PA
Practice address
5450 Wissahickon Ave Apt B232
Philadelphia, PA 19144-5404
Phone
(202) 830-8604
NPI assigned
Sep 16, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DS042837 PA Primary

Addresses

Primary practice location

5450 Wissahickon Ave Apt B232
Philadelphia, PA 19144-5404

Mailing address

5450 Wissahickon Ave Apt B232
Philadelphia, PA 19144-5404
Phone (202) 830-8604

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220121000023 NJ Practitioner - DentistPractitioner - Oral Surgery 2466844683 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS042837PAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Rutgers School of Dental Medicine CurrentSince Jan 12, 2022 Accepting new patients
Rutgers School of Dental Medicine CurrentSince Jan 12, 2022 Accepting new patients
Rutgers Health -University Dental Associates CurrentSince Feb 2, 2023 Accepting new patients

Locations

110 Bergen St
Newark, NJ 07103
Phone (973) 972-3126

110 Bergen St
#D718
Newark, NJ 07103
Phone (973) 972-4242

90 Bergen St
Ste 7700
Newark, NJ 07103
Phone (973) 972-2444

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1396351318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5450 WISSAHICKON AVE APT B232",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191445404",
            "telephone_number": "202-830-8604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5450 WISSAHICKON AVE APT B232",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191445404",
            "telephone_number": "202-830-8604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALWAKEEL",
        "first_name": "MOSTAFA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-16",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS042837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.