=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104104009
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J ENRIQUE TABARINI DDS MS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2011
-----------------------------------------------------
Last Update Date | 12/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11233 SHADOW CREEK PKWY SUITE 121
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77584-7345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-436-0148
-----------------------------------------------------
Fax | 713-436-0892
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11233 SHADOW CREEK PKWY SUITE 121
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77584-7345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-436-0148
-----------------------------------------------------
Fax | 713-436-0892
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | J ENRIQUE TABARINI
-----------------------------------------------------
Credential | DDS, MS
-----------------------------------------------------
Telephone | 205-617-6672
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 23794
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------