Provider Demographics
NPI:1285095281
Name:MICHAEL P TABOR D D S PLLC
Entity type:Organization
Organization Name:MICHAEL P TABOR D D S PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:TABOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-320-3210
Mailing Address - Street 1:310 23RD AVE N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1525
Mailing Address - Country:US
Mailing Address - Phone:615-320-3210
Mailing Address - Fax:615-329-8931
Practice Address - Street 1:310 23RD AVE N
Practice Address - Street 2:SUITE 101
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1525
Practice Address - Country:US
Practice Address - Phone:615-320-3210
Practice Address - Fax:615-329-8931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS25671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty