Provider Demographics
NPI:1689010506
Name:ABDUL-BAQI, AMIN KHADER (DMD)
Entity type:Individual
Prefix:DR
First Name:AMIN
Middle Name:KHADER
Last Name:ABDUL-BAQI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 JACAMAN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6229
Mailing Address - Country:US
Mailing Address - Phone:908-400-3626
Mailing Address - Fax:
Practice Address - Street 1:2412 JACAMAN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6229
Practice Address - Country:US
Practice Address - Phone:908-400-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-18
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX288301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice