Mostafa H Bakir, D.M.D.
Individual provider Active NPI Dentist · Fort Eustis, VA
NPI 1477662575 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1477662575
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DS036352 (PA)
- Practice address
- 577 Sternberg Ave
HQ U.S. Army Dental Activity Credentials Office
Fort Eustis, VA 23604-5311 - Phone
- (757) 314-7944
- Fax
- (757) 314-7942
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160111000901 | MD | Order and Referring Only - Dentist |
1153623988 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS036352 | PA | MD | Dentist |
| 15195 | MD | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS036352 | PA | Yes |
Addresses
Primary practice location
577 Sternberg Ave
HQ U.S. Army Dental Activity Credentials Office
Fort Eustis, VA 23604-5311
Mailing address
577 Sternberg Ave
HQ U.S. Army Dental Activity Credentials Office
Fort Eustis, VA 23604-5311
Phone (757) 314-7944
Other providers in Fort Eustis, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.