Provider Demographics
NPI:1093391401
Name:TOLBERT-BAILLARGEON, TONIA LATRICE (MBA, MHA, BSDH, RDH)
Entity Type:Individual
Prefix:MRS
First Name:TONIA
Middle Name:LATRICE
Last Name:TOLBERT-BAILLARGEON
Suffix:
Gender:F
Credentials:MBA, MHA, BSDH, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 RIDGEBURY DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8377
Mailing Address - Country:US
Mailing Address - Phone:419-236-1974
Mailing Address - Fax:
Practice Address - Street 1:692 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-1242
Practice Address - Country:US
Practice Address - Phone:419-236-1974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31-011483124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist