Provider Demographics
NPI:1386652493
Name:DE BRY, PHILIP HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:HENRY
Last Name:DE BRY
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:PO BOX 1926
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-1926
Mailing Address - Country:US
Mailing Address - Phone:209-966-3020
Mailing Address - Fax:209-966-4008
Practice Address - Street 1:5131 HIGHWAY 140
Practice Address - Street 2:STE. 6
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338
Practice Address - Country:US
Practice Address - Phone:209-966-3020
Practice Address - Fax:209-966-4008
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA348321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice