Provider Demographics
NPI:1255685061
Name:CHRISTOPHER J AUDINO DDS & DALLEN L PHILLIPS DDS, INC.
Entity Type:Organization
Organization Name:CHRISTOPHER J AUDINO DDS & DALLEN L PHILLIPS DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-732-3977
Mailing Address - Street 1:1134 N CHINOWTH ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-7896
Mailing Address - Country:US
Mailing Address - Phone:559-732-3977
Mailing Address - Fax:559-732-6108
Practice Address - Street 1:1134 N CHINOWTH ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-7896
Practice Address - Country:US
Practice Address - Phone:559-732-3977
Practice Address - Fax:559-732-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty