Provider Demographics
NPI:1407989437
Name:PHILLIPS, DANIEL E (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
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 1:4001 E HENRIETTA RD
Mailing Address - Street 2:P.O. BOX 580
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9780
Mailing Address - Country:US
Mailing Address - Phone:585-334-5544
Mailing Address - Fax:585-334-6308
Practice Address - Street 1:4001 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9780
Practice Address - Country:US
Practice Address - Phone:585-334-5544
Practice Address - Fax:585-334-6308
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043684-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice