Healthcare Provider Details

I. General information

NPI: 1225122104
Provider Name (Legal Business Name): PHILLIPS & NIEMEYER, D.D.S., P.L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 NW BYRON STREET
SILVERDALE WA
98383
US

IV. Provider business mailing address

3637 NW BYRON ST
SILVERDALE WA
98383-9127
US

V. Phone/Fax

Practice location:
  • Phone: 360-692-9560
  • Fax: 360-692-1729
Mailing address:
  • Phone: 360-692-9560
  • Fax: 360-692-1729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number602181283
License Number StateWA

VIII. Authorized Official

Name: JASON NIEMEYER
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 360-692-9560