Provider Demographics
NPI:1275619124
Name:PHILBERT, RAWLE FABIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAWLE
Middle Name:FABIAN
Last Name:PHILBERT
Suffix:
Gender:M
Credentials:DDS
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 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-0600
Mailing Address - Fax:214-645-2762
Practice Address - Street 1:6333 FOREST PARK RD SUITE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-5504
Practice Address - Country:US
Practice Address - Phone:214-645-3999
Practice Address - Fax:214-645-3989
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0428471223S0112X
TX37107204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery