Provider Demographics
NPI:1659347268
Name:PHILLIPS, THADDEUS HILLIARD III (DMD/MD)
Entity Type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:HILLIARD
Last Name:PHILLIPS
Suffix:III
Gender:M
Credentials:DMD/MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC #3 BOX 128
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96266-0001
Mailing Address - Country:KR
Mailing Address - Phone:01194315-784-2108
Mailing Address - Fax:
Practice Address - Street 1:51 MEDICAL GROUP/ DENTAL SQUADRON
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96278-2060
Practice Address - Country:KR
Practice Address - Phone:01194315-784-2108
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045133-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist