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General NPI Number Information
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NPI Number | 1285653378
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Entity Type | Individual
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Provider Name | DIMITRY TIMOTHY PHILIPOVITCH DDS
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 06/04/2014
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Provider Practice Location Address
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Address Line | 2813 COFFEE RD STE B2
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City | MODESTO
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State | CA
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Zip | 95355-1755
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Country | US
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Telephone | 209-526-4884
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Fax | 209-526-6133
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Provider Business Mailing Address
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Address Line | 3601 SPRINGBROOK ST
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City | DALLAS
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State | TX
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Zip | 75205-4338
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Country | US
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Telephone | 415-519-7374
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Fax |
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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 | 40386
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 29435
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License Number State | TX
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