Provider Demographics
NPI:1679639538
Name:PHILLIPI, WILLIAM ROBERTSON JR (DMD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ROBERTSON
Last Name:PHILLIPI
Suffix:JR
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 1:340 EARL STREET
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AL
Mailing Address - Zip Code:36726
Mailing Address - Country:US
Mailing Address - Phone:334-682-4145
Mailing Address - Fax:334-682-2266
Practice Address - Street 1:340 EARL STREET
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AL
Practice Address - Zip Code:36726
Practice Address - Country:US
Practice Address - Phone:334-682-4145
Practice Address - Fax:334-682-2266
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL 3618122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL95356OtherBCBS OF AL