Provider Demographics
NPI:1831760487
Name:ABOUMAHBOUB, TARA (DMD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ABOUMAHBOUB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 MAIN ST APT 805
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-3665
Mailing Address - Country:US
Mailing Address - Phone:561-866-6692
Mailing Address - Fax:
Practice Address - Street 1:425 WALNUT ST STE 201
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-3939
Practice Address - Country:US
Practice Address - Phone:561-866-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26134122300000X
FL26134122300000X
OH30.026572122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist