Provider Demographics
NPI:1467606665
Name:PHILLIPS, RICHARD STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STEVEN
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:PO BOX 74324
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-0145
Mailing Address - Country:US
Mailing Address - Phone:949-412-5392
Mailing Address - Fax:949-498-4446
Practice Address - Street 1:224 W AVENIDA VALENCIA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4242
Practice Address - Country:US
Practice Address - Phone:949-412-5392
Practice Address - Fax:949-498-4446
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27819122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist