Provider Demographics
NPI:1053042309
Name:SODI, MUSTAFA (DMD)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:SODI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28610 VALLEY CREST LN
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-2163
Mailing Address - Country:US
Mailing Address - Phone:619-635-1860
Mailing Address - Fax:
Practice Address - Street 1:28610 VALLEY CREST LN
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-2163
Practice Address - Country:US
Practice Address - Phone:619-635-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38585122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist