| NPI | 1548462369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL W PHILLIPS Dentist 202-463-2090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC 3717) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC 5041) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2020-08-22 |