Provider Demographics
NPI:1679866032
Name:POPOOLA, SAIDAT BAMIDELE (RDH, BS)
Entity Type:Individual
Prefix:
First Name:SAIDAT
Middle Name:BAMIDELE
Last Name:POPOOLA
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10570 FAULKNER RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2230
Mailing Address - Country:US
Mailing Address - Phone:443-547-0419
Mailing Address - Fax:
Practice Address - Street 1:200 GIRARD ST
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-3466
Practice Address - Country:US
Practice Address - Phone:240-720-0439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6194124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist