Provider Demographics
NPI:1386663334
Name:PHILLIPS, ROGER A (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
Last Name:PHILLIPS
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 1:31 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-2131
Mailing Address - Country:US
Mailing Address - Phone:603-643-3190
Mailing Address - Fax:603-643-3017
Practice Address - Street 1:31 S PARK ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2131
Practice Address - Country:US
Practice Address - Phone:603-643-3190
Practice Address - Fax:603-643-3017
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH26021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice