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General NPI Number Information
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NPI Number | 1659347268
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Entity Type | Individual
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Provider Name | THADDEUS HILLIARD PHILLIPS III D.M.D./M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 51 MEDICAL GROUP/ DENTAL SQUADRON
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City | APO
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State | AP
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Zip | 96278-2060
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Country | KR
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Telephone | 011943157842108
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Fax |
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Provider Business Mailing Address
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Address Line | PSC #3 BOX 128
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City | APO
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State | AP
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Zip | 96266-0001
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Country | KR
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Telephone | 011943157842108
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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 | 045133-1
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License Number State | NY
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