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General NPI Number Information
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NPI Number | 1578730305
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Entity Type | Organization
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Legal Business Name | TABIJE DENTAL CORP.
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 173 BUTCHER RD
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City | VACAVILLE
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State | CA
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Zip | 95687-5693
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Country | US
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Telephone | 707-455-7910
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Fax | 707-455-7912
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Provider Business Mailing Address
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Address Line | 173 BUTCHER RD
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City | VACAVILLE
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State | CA
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Zip | 95687-5693
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Country | US
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Telephone | 707-455-7910
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Fax | 707-455-7912
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROMEO DIAZ TABIJE
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Credential | D.M.D.
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Telephone | 707-455-7910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 36617
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License Number State | CA
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