Provider Demographics
NPI:1538292081
Name:PHILLIP M. DRLICKA, D.D.S., PA
Entity Type:Organization
Organization Name:PHILLIP M. DRLICKA, D.D.S., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:MARTINE
Authorized Official - Last Name:DRLICKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-455-1323
Mailing Address - Street 1:901 N NEW WARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-4250
Mailing Address - Country:US
Mailing Address - Phone:850-455-1323
Mailing Address - Fax:
Practice Address - Street 1:901 N NEW WARRINGTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-4250
Practice Address - Country:US
Practice Address - Phone:850-455-1323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12681261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental