Provider Demographics
NPI:1841320942
Name:TAGBO, IJEOMA (DMD)
Entity type:Individual
Prefix:
First Name:IJEOMA
Middle Name:
Last Name:TAGBO
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 1:11101 RESORT RD # 190
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2086
Mailing Address - Country:US
Mailing Address - Phone:410-690-4533
Mailing Address - Fax:
Practice Address - Street 1:8850 COLUMBIA 100 PKWY STE 310
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2377
Practice Address - Country:US
Practice Address - Phone:860-680-6119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist