Provider Demographics
NPI:1235552266
Name:PHILIP, JAIME (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:PHILIP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 GUY LOMBARDO AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3715
Mailing Address - Country:US
Mailing Address - Phone:516-546-6709
Mailing Address - Fax:
Practice Address - Street 1:80 GUY LOMBARDO AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3715
Practice Address - Country:US
Practice Address - Phone:516-546-6709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0580311122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist