Healthcare Provider Details

I. General information

NPI: 1003817750
Provider Name (Legal Business Name): DAVID M PHILLIPS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S RUSS ST
KING CITY CA
93930-2925
US

IV. Provider business mailing address

222 S RUSS ST
KING CITY CA
93930-2925
US

V. Phone/Fax

Practice location:
  • Phone: 831-385-5616
  • Fax: 831-385-9015
Mailing address:
  • Phone: 831-385-5616
  • Fax: 831-385-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number27185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: