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General NPI Number Information
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NPI Number | 1225160195
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Entity Type | Individual
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Provider Name | GLENN NORMAN PHILLIPS DMD
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Gender | Male
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 235 MADISON AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481
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Country | US
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Telephone | 201-891-5154
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Fax | 201-891-4675
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Provider Business Mailing Address
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Address Line | 235 MADISON AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481
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Country | US
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Telephone | 201-891-5154
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Fax | 201-891-4675
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI01837600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 22DI01837600
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License Number State | NJ
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