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General NPI Number Information
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NPI Number | 1154434918
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Entity Type | Individual
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Provider Name | THADDEUS H PHILLIPS JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1516 N 2ND ST
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City | HARRISBURG
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State | PA
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Zip | 17102-2556
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Country | US
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Telephone | 717-234-6715
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Fax | 717-234-8514
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Provider Business Mailing Address
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Address Line | 1516 N 2ND ST
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City | HARRISBURG
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State | PA
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Zip | 17102-2556
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Country | US
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Telephone | 717-234-6715
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Fax | 717-234-8514
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS014636L
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License Number State | PA
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