Provider Demographics
NPI:1750793212
Name:SHINTA, MUSTAFA (DDS)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:SHINTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 BELLMEAD DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3972
Mailing Address - Country:US
Mailing Address - Phone:281-748-0132
Mailing Address - Fax:
Practice Address - Street 1:4922 BELLMEAD DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3972
Practice Address - Country:US
Practice Address - Phone:281-748-0132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30012122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist