Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901016029 | MI |
NPI | 1003255035 |
---|---|
Provider Name | Dennis S Phillips |
First Address | Detroit, MI 48201-2153 |
Second Address | Detroit, MI 48201-2153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2013 |
Last Update Date | 24/06/2013 |