Healthcare Provider Details

I. General information

NPI: 1184667115
Provider Name (Legal Business Name): HUGH RICHARD PHILLIS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W HOLLIS ST SUITE 201
NASHUA NH
03062-1358
US

IV. Provider business mailing address

505 W HOLLIS ST SUITE 201
NASHUA NH
03062-1358
US

V. Phone/Fax

Practice location:
  • Phone: 603-889-2520
  • Fax: 603-889-5192
Mailing address:
  • Phone: 603-889-2520
  • Fax: 603-889-5192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1776
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: