Provider Demographics
NPI:1629183124
Name:PHILP, DIANNE TYLER (DMD)
Entity type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:TYLER
Last Name:PHILP
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:DIANNE
Other - Middle Name:TYLER
Other - Last Name:PILKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 6616
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78762-6616
Mailing Address - Country:US
Mailing Address - Phone:512-473-8444
Mailing Address - Fax:512-473-2025
Practice Address - Street 1:2719 E 7TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3907
Practice Address - Country:US
Practice Address - Phone:512-473-8444
Practice Address - Fax:512-473-2025
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14115122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist