Provider Demographics
NPI:1528323581
Name:TABORDA, STEVE D
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:D
Last Name:TABORDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 291609
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-1609
Mailing Address - Country:US
Mailing Address - Phone:386-267-4718
Mailing Address - Fax:386-265-1486
Practice Address - Street 1:3751 SOUTH CLYDE MORRIS BLVD
Practice Address - Street 2:UNIT 7
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-2356
Practice Address - Country:US
Practice Address - Phone:386-267-4718
Practice Address - Fax:386-265-1486
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist