Mustafa Adami
Individual provider Active NPI Periodontics · Redlands, CA
NPI 1750739983 · NPPES record last updated Apr 10, 2025
Key facts
- NPI
- 1750739983
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- 100193 (CA)
- Practice address
- 107 Jennifer St
Redlands, CA 92373-4957 - Phone
- (909) 388-2427
- NPI assigned
- May 27, 2016
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170302001447 | CA | Order and Referring Only - Other (Non-Physician) | 6204110687 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100193 | CA | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 100193 | CA | Yes |
| Dentist | 122300000X | 100193 | CA |
Addresses
Primary practice location
107 Jennifer St
Redlands, CA 92373-4957
Mailing address
107 Jennifer St
Redlands, CA 92373-4957
Other providers in Redlands, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 10, 2025. 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.