Provider Demographics
NPI:1447650809
Name:E KEITH PHILLIPS DDS
Entity type:Organization
Organization Name:E KEITH PHILLIPS DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLERY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-219-0451
Mailing Address - Street 1:10405 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3357
Mailing Address - Country:US
Mailing Address - Phone:301-219-0451
Mailing Address - Fax:
Practice Address - Street 1:10405 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-3357
Practice Address - Country:US
Practice Address - Phone:301-219-0451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4705332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition