Tumouh Talib Al-Allaq, DDS
Individual provider Active NPI General Practice Dentistry · Cambridge, MD
NPI 1497058051 · NPPES record last updated Oct 29, 2020
Key facts
- NPI
- 1497058051
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- LL814 (MD)
- Practice address
- 503 Muir St Ste a
Cambridge, MD 21613-1848 - Phone
- (410) 228-9381
- Fax
- (833) 916-1011
- NPI assigned
- Dec 20, 2010
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171006002509 | MD | Order and Referring Only - Dentist |
4385919968 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Interoperability endpoints
- al-allaq.tumouh.1@20853.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | LL814 | MD | Yes |
Addresses
Primary practice location
503 Muir St Ste a
Cambridge, MD 21613-1848
Mailing address
503 Muir St Ste a
Cambridge, MD 21613-1848
Phone (410) 228-9381
Other practice location 1
12165 Elm St
Princess Anne, MD 21853-1358
Phone (410) 651-5151
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 127518600 | Medicaid | MD | |
| 119591300 | Medicaid | MD |
Other providers in Cambridge, MD
- Adventist Healthcare, Inc
- Adventist Healthcare, Inc
- Affiliated Sante Group
- Agnprx LLC
- Mahbuba Akhter
- Allan a Anderson MD LLC
- Farah Alli
- Andres Manuel Alvarez Deal
- Sohail Aman
- Amana Healthcare LLC
All providers in Cambridge, MD · General Practice Dentistry in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.