Provider Demographics
NPI:1356235998
Name:FROMM, PHILLIP (DMD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:FROMM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 E MAYO BLVD APT 4302
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5632
Mailing Address - Country:US
Mailing Address - Phone:480-322-1987
Mailing Address - Fax:
Practice Address - Street 1:18855 N 83RD AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2806
Practice Address - Country:US
Practice Address - Phone:623-887-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0125321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice