MEDICARE: TABASOM POURBEIK

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	122300000X	Dentist	8977	NC
2	1223G0001X	General Practice Dentistry	29687	TX

General Provider Information

NPI Number	:	1972816304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABASOM POURBEIK

Provider Business Mailing Address
First Line	:	7841 ALEXANDER PROMENADE PL STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-1914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7841 ALEXANDER PROMENADE PL STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-1914
Country	:	US
Telephone Number	:	919-354-5400
Fax Number	:

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

Provider Enumeration Date	:	07/14/2010
Last Update Date	:	03/11/2014

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Directions to “ TABASOM POURBEIK ” Practice Location

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