Provider Demographics
NPI:1609340884
Name:WALTON, TABITHA PHILLIPS (RDH)
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:PHILLIPS
Last Name:WALTON
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 1:176 POOLES RD
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-2426
Mailing Address - Country:US
Mailing Address - Phone:864-490-9967
Mailing Address - Fax:
Practice Address - Street 1:224 S NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4873
Practice Address - Country:US
Practice Address - Phone:704-864-0337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
8005124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist