Individual provider Active NPI

Ahmed M. Mostafa, D.M.D

  • Dentist
  • Trinity, FL
National Provider Identifier
1407977911
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN15454 Issued in FL
Practice address
3144 Little Rd
Trinity, FL 34655-1864
Phone
(727) 376-9696
Fax
(727) 376-2674
NPI assigned
Apr 2, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN15454 FL Primary

Addresses

Primary practice location

3144 Little Rd
Trinity, FL 34655-1864

Mailing address

3144 Little Rd
Trinity, FL 34655-1864
Phone (727) 376-9696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20151019000508 FL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 9133438930

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407977911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3144 LITTLE RD",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346551864",
            "telephone_number": "727-376-9696",
            "fax_number": "727-376-2674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3144 LITTLE RD",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346551864",
            "telephone_number": "727-376-9696",
            "fax_number": "727-376-2674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSTAFA",
        "first_name": "AHMED",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN15454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trinity, FL

Sources for this page

Verify at the official NPI Registry.