Provider Demographics
NPI:1225122104
Name:PHILLIPS & NIEMEYER, D.D.S., P.L.L.C
Entity Type:Organization
Organization Name:PHILLIPS & NIEMEYER, D.D.S., P.L.L.C
Other - Org Name:SILVERDALE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-692-9560
Mailing Address - Street 1:3637 NW BYRON ST
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9127
Mailing Address - Country:US
Mailing Address - Phone:360-692-9560
Mailing Address - Fax:360-692-1729
Practice Address - Street 1:3637 NW BYRON STREET
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383
Practice Address - Country:US
Practice Address - Phone:360-692-9560
Practice Address - Fax:360-692-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6021812831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1790886141OtherNPI
WA1184725657OtherNPI
WA1083715569OtherNPI