Provider Demographics
NPI:1487857637
Name:PHILLIPS, TINA M (RDH)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FUNNY BONE CT
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4844
Mailing Address - Country:US
Mailing Address - Phone:856-629-3466
Mailing Address - Fax:
Practice Address - Street 1:820 KINGS HWY S
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2520
Practice Address - Country:US
Practice Address - Phone:856-428-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHI003838124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist