Provider Demographics
NPI:1013174168
Name:KAISER, PHILIP WERNER (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:WERNER
Last Name:KAISER
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 1:3722 BROWNS POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-2056
Mailing Address - Country:US
Mailing Address - Phone:253-205-7075
Mailing Address - Fax:
Practice Address - Street 1:16810 MERIDIAN E
Practice Address - Street 2:SUITE J107
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9604
Practice Address - Country:US
Practice Address - Phone:253-848-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0543841223S0112X
CA615261223S0112X
WADE607458071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery