Provider Demographics
NPI:1881722114
Name:PHILIPS, FREDERICK THOMAS JR (DDS)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:THOMAS
Last Name:PHILIPS
Suffix:JR
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 1:737 EVERHART RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1999
Mailing Address - Country:US
Mailing Address - Phone:361-992-9871
Mailing Address - Fax:361-334-5983
Practice Address - Street 1:737 EVERHART RD.
Practice Address - Street 2:SUITE A
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1999
Practice Address - Country:US
Practice Address - Phone:361-992-9871
Practice Address - Fax:361-334-5983
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice