Provider Demographics
NPI:1942277793
Name:DRLICKA, PHILLIP MARTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:MARTINE
Last Name:DRLICKA
Suffix:
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 1:901N NEW WARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-4250
Mailing Address - Country:US
Mailing Address - Phone:850-455-1323
Mailing Address - Fax:850-453-2307
Practice Address - Street 1:901 N WARRINGTON RD
Practice Address - Street 2:
Practice Address - City:PENSOCOLA
Practice Address - State:FL
Practice Address - Zip Code:32506
Practice Address - Country:US
Practice Address - Phone:850-455-1323
Practice Address - Fax:850-453-2307
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12681122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist