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NPI Code Detail

MEDICARE: CORINNE ELLEN TABERT DDS

MEDICARE: CORINNE ELLEN TABERT DDS
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
11223G0001XGeneral Practice Dentistry0401411905VA
2122300000XDentist63964CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366621435
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORINNE ELLEN TABERT DDS
Provider Business Mailing Address
First Line : 21676 POTOMAC VIEW DR
Second Line :
City : LEONARDTOWN
State : MD
Zip : 20650-2134
Country : US
Telephone Number : 402-202-4148
Fax Number :
Provider Business Practice Location Address
First Line : 29795 THREE NOTCH RD
Second Line :
City : CHARLOTTE HALL
State : MD
Zip : 20622-4106
Country : US
Telephone Number : 301-290-0001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2007
Last Update Date : 03/17/2018

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Directions to “ CORINNE ELLEN TABERT DDS” Practice Location

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