Provider Demographics
NPI:1376426676
Name:SMITH, PHILIP (DMD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 BUTLER PIKE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2107
Mailing Address - Country:US
Mailing Address - Phone:610-825-2327
Mailing Address - Fax:610-825-2327
Practice Address - Street 1:3048 BUTLER PIKE
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2107
Practice Address - Country:US
Practice Address - Phone:610-825-2327
Practice Address - Fax:610-825-2327
Is Sole Proprietor?:No
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS045366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist