Provider Demographics
NPI:1235345844
Name:STEPHEN TABORI DMD LLC
Entity Type:Organization
Organization Name:STEPHEN TABORI DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TABORI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-698-9595
Mailing Address - Street 1:171 MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-1500
Mailing Address - Country:US
Mailing Address - Phone:732-698-9595
Mailing Address - Fax:732-698-9595
Practice Address - Street 1:171 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SOUTH RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08882-1500
Practice Address - Country:US
Practice Address - Phone:732-698-9595
Practice Address - Fax:732-698-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 021259122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty