Provider Demographics
NPI:1720215379
Name:TAFO-TABUE, HENDRICK BASTIAAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENDRICK
Middle Name:BASTIAAN
Last Name:TAFO-TABUE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11627 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2620
Mailing Address - Country:US
Mailing Address - Phone:804-897-8550
Mailing Address - Fax:
Practice Address - Street 1:11627 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2620
Practice Address - Country:US
Practice Address - Phone:804-897-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413401122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist