Individual provider · NPI-1

Charles W Phillips, DD

Dentist, General Practice · Kodiak, AK

NPI number1912091935
StatusActive
Last updated in NPPESJul 9, 2007

Details

NPI
1912091935
Entity type
Individual (NPI-1)
Name
Charles W Phillips
Credential
DD
Sex
Male
Sole proprietor
Yes
Enumeration date
Oct 3, 2006
Last updated
Jul 9, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice1169AKYes

Practice location

3449 E Rezanof Dr
Kodiak, AK 99615-6952

Phone 907-486-9800 · Fax 907-486-9898

Mailing address

3449 E Rezanof Dr
Kodiak, AK 99615-6952

Phone 907-486-9800 · Fax 907-486-9898

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