Provider Demographics
NPI:1033392303
Name:ALBU, TEODORA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:TEODORA
Middle Name:
Last Name:ALBU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 GRAND CONCOURSE APT 2J
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1905
Mailing Address - Country:US
Mailing Address - Phone:718-563-3305
Mailing Address - Fax:
Practice Address - Street 1:2960 GRAND CONCOURSE APT 2J
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1905
Practice Address - Country:US
Practice Address - Phone:718-563-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045685122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01663390Medicaid