Provider Demographics
NPI:1871614651
Name:HARWOOD, PHILLIP CAMERON (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:CAMERON
Last Name:HARWOOD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5226 DEER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3771
Mailing Address - Country:US
Mailing Address - Phone:303-530-4680
Mailing Address - Fax:
Practice Address - Street 1:2525 ARAPAHOE AVE
Practice Address - Street 2:B-1
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6720
Practice Address - Country:US
Practice Address - Phone:303-442-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO64841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice