Provider Demographics
NPI:1811441793
Name:IBRIK, TAJ (DDS)
Entity type:Individual
Prefix:DR
First Name:TAJ
Middle Name:
Last Name:IBRIK
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 1:1659 W STATE HIGHWAY 46
Mailing Address - Street 2:SUITE 180
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-4744
Mailing Address - Country:US
Mailing Address - Phone:830-625-6600
Mailing Address - Fax:
Practice Address - Street 1:1659 W STATE HIGHWAY 46
Practice Address - Street 2:SUITE 180
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-4744
Practice Address - Country:US
Practice Address - Phone:830-625-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX321341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice