Provider Demographics
NPI:1821085465
Name:TABATCHNICK, LARRY (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:TABATCHNICK
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 ROBESON ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5549
Mailing Address - Country:US
Mailing Address - Phone:910-483-9546
Mailing Address - Fax:910-483-8550
Practice Address - Street 1:2409 ROBESON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5549
Practice Address - Country:US
Practice Address - Phone:910-483-9546
Practice Address - Fax:910-483-8550
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery