Provider Demographics
NPI:1871155812
Name:MUSTEDANAGIC, DENIS (DMD)
Entity type:Individual
Prefix:DR
First Name:DENIS
Middle Name:
Last Name:MUSTEDANAGIC
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 1:9 SHORELINE TRCE
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4212
Mailing Address - Country:US
Mailing Address - Phone:423-314-7497
Mailing Address - Fax:
Practice Address - Street 1:703 N GOLDEN STATE BLVD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3953
Practice Address - Country:US
Practice Address - Phone:209-216-4198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-30
Last Update Date:2019-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist