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General NPI Number Information
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NPI Number | 1538368154
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Entity Type | Organization
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Legal Business Name | DR. BRUCE TABER D.D.S INC
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 11175 MOUNTAIN VIEW AVE SUITE N
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City | LOMA LINDA
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State | CA
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Zip | 92354-3865
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Country | US
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Telephone | 909-796-2299
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Fax | 909-796-2509
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Provider Business Mailing Address
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Address Line | 11175 MOUNTAIN VIEW AVE SUITE N
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City | LOMA LINDA
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State | CA
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Zip | 92354-3865
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Country | US
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Telephone | 909-796-2299
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Fax | 909-796-2509
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Authorized Official
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Title or Position | DENTIST
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Name | DR. BRUCE LEE TABER
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Credential | D.D.S
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Telephone | 909-796-2299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 34906
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License Number State | CA
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