Healthcare Provider Details

I. General information

NPI: 1356180632
Provider Name (Legal Business Name): HAYDEN THOMAS PHILLIPS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S IDAHO RD STE 260
APACHE JUNCTION AZ
85119-2379
US

IV. Provider business mailing address

6176 W ORAIBI DR
GLENDALE AZ
85308-5214
US

V. Phone/Fax

Practice location:
  • Phone: 480-485-9580
  • Fax:
Mailing address:
  • Phone: 602-908-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012133
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: