Provider Demographics
NPI:1356180632
Name:PHILLIPS, HAYDEN THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:HAYDEN
Middle Name:THOMAS
Last Name:PHILLIPS
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 1:6176 W ORAIBI DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5214
Mailing Address - Country:US
Mailing Address - Phone:602-908-7408
Mailing Address - Fax:
Practice Address - Street 1:110 S IDAHO RD STE 260
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85119-2379
Practice Address - Country:US
Practice Address - Phone:480-485-9580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD012133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist