Provider Demographics
NPI:1285889170
Name:TOLBERT, PHILNITA R HINES (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILNITA
Middle Name:R HINES
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:PHILNITA
Other - Middle Name:R
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:124 PEARL ST STE 207
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5375
Mailing Address - Country:US
Mailing Address - Phone:734-481-0180
Mailing Address - Fax:
Practice Address - Street 1:124 PEARL ST STE 207
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5375
Practice Address - Country:US
Practice Address - Phone:734-481-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist