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General NPI Number Information
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NPI Number | 1790842672
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Entity Type | Individual
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Provider Name | HENRY PHILLIPS DDS
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 1110 N WESTERN AVE SUITE # 205
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City | LOS ANGELES
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State | CA
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Zip | 90029-1088
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Country | US
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Telephone | 323-476-2114
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Fax |
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Provider Business Mailing Address
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Address Line | 4712 ADMIRALTY WAY # 461
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6905
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Country | US
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Telephone | 310-733-7150
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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 | 49394
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License Number State | CA
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