Provider Demographics
NPI:1437159357
Name:TABOR, CHRISTIAN SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:SCOTT
Last Name:TABOR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12000 WYNDHAM LAKE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7072
Mailing Address - Country:US
Mailing Address - Phone:804-364-7122
Mailing Address - Fax:804-364-8898
Practice Address - Street 1:12000 WYNDHAM LAKE DR
Practice Address - Street 2:SUITE A
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-7072
Practice Address - Country:US
Practice Address - Phone:804-364-7122
Practice Address - Fax:804-364-8898
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014102491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice