Provider Demographics
NPI:1851380505
Name:TABOR, CARL FRANK (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:FRANK
Last Name:TABOR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:305 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-1343
Mailing Address - Country:US
Mailing Address - Phone:970-532-3005
Mailing Address - Fax:970-493-2188
Practice Address - Street 1:1355 RIVERSIDE AVE
Practice Address - Street 2:D
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4368
Practice Address - Country:US
Practice Address - Phone:970-493-0999
Practice Address - Fax:970-493-2188
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO54961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice