MEDICARE: DR. VLADIMIR Y TABAKMAN D.D.S, M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22101	TX

General Provider Information

NPI Number	:	1417032467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VLADIMIR Y TABAKMAN D.D.S, M.S.

Provider Business Mailing Address
First Line	:	1510 ELDRIDGE PKWY
Second Line	:	SUITE 114
City	:	HOUSTON
State	:	TX
Zip	:	77077-1760
Country	:	US
Telephone Number	:	281-752-4222
Fax Number	:	281-752-4544

Provider Business Practice Location Address
First Line	:	1510 ELDRIDGE PKWY
Second Line	:	SUITE 114
City	:	HOUSTON
State	:	TX
Zip	:	77077-1760
Country	:	US
Telephone Number	:	281-752-4222
Fax Number	:	281-752-4544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	01/14/2013

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