Healthcare Provider Details

I. General information

NPI: 1629025564
Provider Name (Legal Business Name): S C TOLBERT DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 C MELROSE RD
FAYETTEVILLE NC
28304
US

IV. Provider business mailing address

3419 C MELROSE RD
FAYETTEVILLE NC
28304
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-6116
  • Fax: 910-484-5950
Mailing address:
  • Phone: 910-484-6116
  • Fax: 910-484-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3726
License Number StateNC

VIII. Authorized Official

Name: S C TOLBERT
Title or Position: PRESIDENT
Credential: D D S P A
Phone: 910-484-6116