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General NPI Number Information
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NPI Number | 1396026209
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Entity Type | Organization
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Legal Business Name | PHILLIPS DENTISTRY, PS.
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Dates
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Enumeration Date | 09/06/2011
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Last Update Date | 01/08/2016
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Provider Practice Location Address
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Address Line | 5615 VALLEY AVE E
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City | TACOMA
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State | WA
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Zip | 98424-2060
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Country | US
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Telephone | 253-922-6822
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Fax | 253-922-3513
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Provider Business Mailing Address
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Address Line | 5615 VALLEY AVE E
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City | FIFE
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State | WA
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Zip | 98424-2060
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Country | US
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Telephone | 253-922-6822
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Fax | 253-922-3513
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Authorized Official
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Title or Position | OWNER
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Name | KEITH MARTIN PHILLIPS
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Credential | D.M.D., M.S.D.
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Telephone | 253-922-6822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | WA
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