Provider Demographics
NPI:1104145648
Name:JUSTICE, TABITHA LEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:TABITHA
Middle Name:LEIGH
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:TABITHA
Other - Middle Name:LEIGH
Other - Last Name:HAUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 BLIZZARD DR
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-6422
Mailing Address - Country:US
Mailing Address - Phone:304-420-0922
Mailing Address - Fax:304-420-0924
Practice Address - Street 1:1401 BLIZZARD DRIVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-6422
Practice Address - Country:US
Practice Address - Phone:304-420-0922
Practice Address - Fax:304-420-0924
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice