MEDICARE: MARK G PHILLIPE DDS

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
1	122300000X	Dentist	D9615	OR

General Provider Information

NPI Number	:	1487933842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK G PHILLIPE DDS

Provider Business Mailing Address
First Line	:	31571 CANYON ESTATES DR STE 117
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92532-0471
Country	:	US
Telephone Number	:	951-244-9495
Fax Number	:

Provider Business Practice Location Address
First Line	:	31571 CANYON ESTATES DR STE 117
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92532-0471
Country	:	US
Telephone Number	:	951-244-9495
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	07/24/2020

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Directions to “ MARK G PHILLIPE DDS” Practice Location

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