Provider Demographics
NPI:1639132749
Name:ABUBAKER, ABUBAKER OMAR (BDS DMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ABUBAKER
Middle Name:OMAR
Last Name:ABUBAKER
Suffix:
Gender:M
Credentials:BDS DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N 11TH ST
Mailing Address - Street 2:P O BOX 980566
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-5045
Mailing Address - Country:US
Mailing Address - Phone:804-828-4249
Mailing Address - Fax:
Practice Address - Street 1:520 N 12TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1610
Practice Address - Country:US
Practice Address - Phone:804-828-4249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008351223S0112X
VA0401008355204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010036488Medicaid
VA010036488Medicaid
VA003464M30Medicare PIN