Provider Demographics
NPI:1760200174
Name:TOMLIN, CHRISTINA NICHOLE (RDH)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NICHOLE
Last Name:TOMLIN
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 1:13961 CHARLESTON RD
Mailing Address - Street 2:
Mailing Address - City:KENNA
Mailing Address - State:WV
Mailing Address - Zip Code:25248-7056
Mailing Address - Country:US
Mailing Address - Phone:304-531-3173
Mailing Address - Fax:
Practice Address - Street 1:500 VIRGINIA ST E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2164
Practice Address - Country:US
Practice Address - Phone:681-519-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3056124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist