Provider Demographics
NPI:1912550013
Name:ALBAKER, TAIBAH M A M J (BDM)
Entity Type:Individual
Prefix:DR
First Name:TAIBAH
Middle Name:M A M J
Last Name:ALBAKER
Suffix:
Gender:F
Credentials:BDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 980566
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0566
Mailing Address - Country:US
Mailing Address - Phone:804-828-9095
Mailing Address - Fax:
Practice Address - Street 1:VCU SCHOOL OF DENTISTRY - DEPT OF PEDIATRIC DENTISTRY
Practice Address - Street 2:521 N. 11 ST, SUITE 317
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0506
Practice Address - Country:US
Practice Address - Phone:804-467-7868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0442000372390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program