1225036759 NPI number — DR. WILLIAM RALPH PHILLIPS III DDS, MD

Table of content: DR. WILLIAM RALPH PHILLIPS III DDS, MD (NPI 1225036759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225036759 NPI number — DR. WILLIAM RALPH PHILLIPS III DDS, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
WILLIAM
Provider Middle Name:
RALPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DDS, MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225036759
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/28/2006
NPI Reactivation Date:
09/27/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8201 PRESTON RD
Provider Second Line Business Mailing Address:
SUITE 260
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75225-6203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-528-5500
Provider Business Mailing Address Fax Number:
214-528-5510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8201 PRESTON RD
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75225-6203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-528-5500
Provider Business Practice Location Address Fax Number:
214-528-5510
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X , with the licence number:  L7848 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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