Provider Demographics
NPI:1578934808
Name:TABOR, BRANDY MARIE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:MARIE
Last Name:TABOR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 WILLIAMS DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3271
Mailing Address - Country:US
Mailing Address - Phone:512-864-1445
Mailing Address - Fax:512-864-1447
Practice Address - Street 1:2411 WILLIAMS DR
Practice Address - Street 2:SUITE 111
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3271
Practice Address - Country:US
Practice Address - Phone:512-864-1445
Practice Address - Fax:512-864-1447
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13525124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist