Provider Demographics
NPI:1780691832
Name:ABSHERE, PHILIP M (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:M
Last Name:ABSHERE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16 ARCADE UNIT 198747
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-1994
Mailing Address - Country:US
Mailing Address - Phone:615-750-0343
Mailing Address - Fax:615-986-1705
Practice Address - Street 1:111 COORS BLVD NW STE E6
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-2009
Practice Address - Country:US
Practice Address - Phone:505-352-3808
Practice Address - Fax:505-352-3811
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK42091223G0001X
TX131641223G0001X
NMDD22861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM862018OtherUNITED CONCORDIA
NM44407572Medicaid
NM9218382OtherDENTAQUEST NM