Provider Demographics
NPI:1588640114
Name:WASHINGTON, PHILLIP III (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:WASHINGTON
Suffix:III
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 1:920 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6735
Mailing Address - Country:US
Mailing Address - Phone:580-223-7060
Mailing Address - Fax:580-226-4314
Practice Address - Street 1:920 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6735
Practice Address - Country:US
Practice Address - Phone:580-223-7060
Practice Address - Fax:580-226-4314
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice