Healthcare Provider Details

I. General information

NPI: 1396557955
Provider Name (Legal Business Name): JOSH PHILIP DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 W HIGGINS AVE
CHICAGO IL
60630-1845
US

IV. Provider business mailing address

859 W ERIE ST APT 601
CHICAGO IL
60642-7297
US

V. Phone/Fax

Practice location:
  • Phone: 847-205-9237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSH PHILIP
Title or Position: OWNER
Credential: DDS
Phone: 847-502-2482