Provider Demographics
NPI:1528262243
Name:PHILLIPS, PAUL ERNEST III (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ERNEST
Last Name:PHILLIPS
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4211 BLAKELY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2407
Mailing Address - Country:US
Mailing Address - Phone:410-256-2009
Mailing Address - Fax:410-256-1612
Practice Address - Street 1:4211 BLAKELY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2407
Practice Address - Country:US
Practice Address - Phone:410-256-2009
Practice Address - Fax:410-256-1612
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD07981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist