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General NPI Number Information
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NPI Number | 1538201991
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Entity Type | Individual
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Provider Name | RICHARD JOHN PHILLIPS JR. DMD
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 632 SOUTH EREMLAND DR
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City | COVINA
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State | CA
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Zip | 91743-3523
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Country | US
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Telephone | 626-339-5891
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Fax | 626-339-5027
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Provider Business Mailing Address
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Address Line | 1768 RUSSET LANE
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City | SAN MARINO
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State | CA
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Zip | 91108-3022
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Country | US
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Telephone | 626-285-9206
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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 | 30687
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License Number State | CA
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