Provider Demographics
NPI:1356440168
Name:PHILLIPS, PAUL STANLEY (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:STANLEY
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 1:1005 39TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5502
Mailing Address - Country:US
Mailing Address - Phone:916-452-7874
Mailing Address - Fax:916-452-9139
Practice Address - Street 1:1005 39TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5502
Practice Address - Country:US
Practice Address - Phone:916-452-7874
Practice Address - Fax:916-452-9139
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice