Active NPI
Hassan Abdalla Mustafa
- Dentist
- Brockton, MA
National Provider Identifier
1497575005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DL100216
- Practice address
- 63 Main St
Brockton, MA 02301-4042 - Phone
- (508) 894-3681
- Fax
- (508) 559-5073
- NPI assigned
- Oct 16, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DL100216 | MA | Primary |
Addresses
Primary practice location
63 Main St
Brockton, MA 02301-4042
Mailing address
4224 Avalon Dr
Acton, MA 01720-3456
Phone (754) 308-9573
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251015001657 | MI | Order and Referring Only - Oral Surgery | 6002303898 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DL100216 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1729036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729036800000",
"number": "1497575005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4224 AVALON DR",
"city": "ACTON",
"state": "MA",
"postal_code": "017203456",
"telephone_number": "754-308-9573"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "63 MAIN ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023014042",
"telephone_number": "508-894-3681",
"fax_number": "508-559-5073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUSTAFA",
"first_name": "HASSAN",
"middle_name": "ABDALLA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-10-16",
"last_updated": "2024-10-16",
"certification_date": "2024-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DL100216",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.