Provider Demographics
NPI:1033327499
Name:TAMBORELLO, ROBERT MARK (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARK
Last Name:TAMBORELLO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5403 FM 1488
Mailing Address - Street 2:#7
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354
Mailing Address - Country:US
Mailing Address - Phone:281-252-6882
Mailing Address - Fax:281-259-6234
Practice Address - Street 1:5403 FM 1488
Practice Address - Street 2:#7
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354
Practice Address - Country:US
Practice Address - Phone:281-252-6882
Practice Address - Fax:281-259-6234
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19094122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist