Provider Demographics
NPI:1659360105
Name:TABOR, MARY BETH (DDS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:TABOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 INDIAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3866
Mailing Address - Country:US
Mailing Address - Phone:615-824-1700
Mailing Address - Fax:615-826-2266
Practice Address - Street 1:131 INDIAN LAKE RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3866
Practice Address - Country:US
Practice Address - Phone:615-824-1700
Practice Address - Fax:615-826-2266
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS82941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice