MEDICARE: DR. CHRISTIAN SCOTT TABOR D.M.D.

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	1223G0001X	General Practice Dentistry	0401410249	VA

General Provider Information

NPI Number	:	1437159357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIAN SCOTT TABOR D.M.D.

Provider Business Mailing Address
First Line	:	12000 WYNDHAM LAKE DR
Second Line	:	SUITE A
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-7072
Country	:	US
Telephone Number	:	804-364-7122
Fax Number	:	804-364-8898

Provider Business Practice Location Address
First Line	:	12000 WYNDHAM LAKE DR
Second Line	:	SUITE A
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-7072
Country	:	US
Telephone Number	:	804-364-7122
Fax Number	:	804-364-8898

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	09/06/2007

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