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General NPI Number Information
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NPI Number | 1356180632
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Entity Type | Individual
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Provider Name | HAYDEN THOMAS PHILLIPS DMD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 110 S IDAHO RD STE 260
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City | APACHE JUNCTION
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State | AZ
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Zip | 85119-2379
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Country | US
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Telephone | 480-485-9580
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Fax |
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Provider Business Mailing Address
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Address Line | 6176 W ORAIBI DR
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City | GLENDALE
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State | AZ
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Zip | 85308-5214
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Country | US
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Telephone | 602-908-7408
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D012133
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License Number State | AZ
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