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General NPI Number Information
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NPI Number | 1497091243
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Entity Type | Organization
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Legal Business Name | KEITH PHILLIPS, DMD, MSD, PS, INC
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Dates
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Enumeration Date | 12/26/2012
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Last Update Date | 12/26/2012
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Provider Practice Location Address
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Address Line | 5619 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 | 253-922-5519
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Fax | 253-922-2719
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Provider Business Mailing Address
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Address Line | 5619 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 | 253-922-5519
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Fax | 253-922-2719
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEITH MARTIN PHILLIPS
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Credential | DMD, MSD
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Telephone | 253-922-5519
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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 | DE00007693
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License Number State | WA
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