Provider Demographics
NPI:1982358537
Name:GAULDIN, TINA F (RDH)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:F
Last Name:GAULDIN
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 1:1008 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4004
Mailing Address - Country:US
Mailing Address - Phone:434-797-8548
Mailing Address - Fax:
Practice Address - Street 1:1008 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4004
Practice Address - Country:US
Practice Address - Phone:434-797-8548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5200124Q00000X
VA0402004170124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist