Provider Demographics
NPI:1609876150
Name:PHILLIPS, STEPHEN WILEY (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WILEY
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 E MAIN ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7404
Mailing Address - Country:US
Mailing Address - Phone:541-772-2414
Mailing Address - Fax:541-772-2523
Practice Address - Street 1:1117 E MAIN ST
Practice Address - Street 2:SUITE #5
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7404
Practice Address - Country:US
Practice Address - Phone:541-772-2414
Practice Address - Fax:541-772-2523
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice