Provider Demographics
NPI:1104104009
Name:J ENRIQUE TABARINI DDS MS PC
Entity type:Organization
Organization Name:J ENRIQUE TABARINI DDS MS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:TABARINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:205-617-6672
Mailing Address - Street 1:11233 SHADOW CREEK PKWY
Mailing Address - Street 2:SUITE 121
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7345
Mailing Address - Country:US
Mailing Address - Phone:713-436-0148
Mailing Address - Fax:713-436-0892
Practice Address - Street 1:11233 SHADOW CREEK PKWY
Practice Address - Street 2:SUITE 121
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7345
Practice Address - Country:US
Practice Address - Phone:713-436-0148
Practice Address - Fax:713-436-0892
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J ENRIQUE TABARINI DDS MS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-26
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23794261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty