Provider Demographics
NPI:1477380715
Name:TABIBIAN, TANYA (DDS)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:TABIBIAN
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 1:19866 PASO ROBLES DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6459
Mailing Address - Country:US
Mailing Address - Phone:626-241-4477
Mailing Address - Fax:
Practice Address - Street 1:24250 TOWN CENTER DR STE 160
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4473
Practice Address - Country:US
Practice Address - Phone:661-702-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist