Provider Demographics
NPI:1245498047
Name:TABOR, RADAH WYLONE (DENTAL HYGIENIST)
Entity type:Individual
Prefix:MRS
First Name:RADAH
Middle Name:WYLONE
Last Name:TABOR
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8410 DATAPOINT DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3220
Mailing Address - Country:US
Mailing Address - Phone:210-949-8900
Mailing Address - Fax:210-949-8901
Practice Address - Street 1:8410 DATAPOINT DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3220
Practice Address - Country:US
Practice Address - Phone:210-949-8900
Practice Address - Fax:210-949-8901
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1288124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist