Provider Demographics
NPI:1568868040
Name:DIMITRY T PHILIPOVITCH, DDS, PLLC
Entity Type:Organization
Organization Name:DIMITRY T PHILIPOVITCH, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILIPOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-519-7374
Mailing Address - Street 1:9400 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5027
Mailing Address - Country:US
Mailing Address - Phone:214-368-0514
Mailing Address - Fax:
Practice Address - Street 1:9400 N CENTRAL EXPY
Practice Address - Street 2:SUITE 220
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5027
Practice Address - Country:US
Practice Address - Phone:214-368-0514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29435122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty