Provider Demographics
NPI:1770707457
Name:SACKS, PHILLIP M (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:M
Last Name:SACKS
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 1:20301 VENTURA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-0922
Mailing Address - Country:US
Mailing Address - Phone:818-348-2507
Mailing Address - Fax:818-348-7055
Practice Address - Street 1:20301 VENTURA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-0922
Practice Address - Country:US
Practice Address - Phone:818-348-2507
Practice Address - Fax:818-348-7055
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA211981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice