MEDICARE: DR. CARL FRANK 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	5496	CO

General Provider Information

NPI Number	:	1851380505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL FRANK TABOR D.M.D.

Provider Business Mailing Address
First Line	:	305 CHEYENNE DR
Second Line	:
City	:	BERTHOUD
State	:	CO
Zip	:	80513-1343
Country	:	US
Telephone Number	:	970-532-3005
Fax Number	:	970-493-2188

Provider Business Practice Location Address
First Line	:	1355 RIVERSIDE AVE
Second Line	:	D
City	:	FT COLLINS
State	:	CO
Zip	:	80524-4368
Country	:	US
Telephone Number	:	970-493-0999
Fax Number	:	970-493-2188

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	07/08/2007

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