Provider Demographics
NPI:1972673226
Name:PHILIPP, JUSTIN JAMES (DMD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JAMES
Last Name:PHILIPP
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 1:3230 S GILBERT RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286
Mailing Address - Country:US
Mailing Address - Phone:480-306-5506
Mailing Address - Fax:
Practice Address - Street 1:3230 S GILBERT RD
Practice Address - Street 2:SUITE 4
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286
Practice Address - Country:US
Practice Address - Phone:480-306-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD64801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice