Provider Demographics
NPI:1346471190
Name:PHILLIP, WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:PHILLIP
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 1:107 E MOUNT VIEW AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-5312
Mailing Address - Country:US
Mailing Address - Phone:509-962-8299
Mailing Address - Fax:509-962-8289
Practice Address - Street 1:107 E MOUNT VIEW AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-5312
Practice Address - Country:US
Practice Address - Phone:509-962-8299
Practice Address - Fax:509-962-8289
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice