Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 00009710 | WA |
N | 1223P0700X | Prosthodontist | 52776 | CA |
Y | 1223P0700X | Prosthodontist | D010253 | AZ |
NPI | 1063609295 |
---|---|
Provider Name | Dr. Phillip Roe |
First Address | Chandler, AZ 85226-5132 |
Second Address | Chandler, AZ 85226-5132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2007 |
Last Update Date | 02/01/2022 |