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NPI Code Detail

MEDICARE: DR. WILSON PHILLIPS DMD

MEDICARE: DR. WILSON PHILLIPS DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDN002360PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DN002360OTHERPAPA STATE LICENSE NUMBER

General Provider Information

NPI Number : 1144679499
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILSON PHILLIPS DMD
Provider Business Mailing Address
First Line : 626 SNYDER AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19148-2419
Country : US
Telephone Number : 267-940-0300
Fax Number :
Provider Business Practice Location Address
First Line : 1319 LINCOLN AVE
Second Line :
City : PROSPECT PARK
State : PA
Zip : 19076-1216
Country : US
Telephone Number : 610-532-5008
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2016
Last Update Date : 06/01/2018

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Directions to “ DR. WILSON PHILLIPS DMD” Practice Location

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