Provider Demographics
NPI:1336466572
Name:PHILLIPS, DENNIS W (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:W
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5963 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3752
Mailing Address - Country:US
Mailing Address - Phone:562-421-8401
Mailing Address - Fax:562-421-0523
Practice Address - Street 1:5963 E SPRING ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-3752
Practice Address - Country:US
Practice Address - Phone:562-421-8401
Practice Address - Fax:562-421-0523
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist