Provider Demographics
NPI:1922408194
Name:HENDRICK B. TAFO-TABUE, DDS, PC
Entity Type:Organization
Organization Name:HENDRICK B. TAFO-TABUE, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENDRICK
Authorized Official - Middle Name:BASTIAAN
Authorized Official - Last Name:TAFO-TABUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-713-2497
Mailing Address - Street 1:12201 TIVERTON LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7015
Mailing Address - Country:US
Mailing Address - Phone:832-713-2497
Mailing Address - Fax:
Practice Address - Street 1:12201 TIVERTON LN
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-7015
Practice Address - Country:US
Practice Address - Phone:832-713-2497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413401122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty