Provider Demographics
NPI:1730396029
Name:ECHO, PHILIP M (DMD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:M
Last Name:ECHO
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 1:187 WASHINGTON AVENUE, SUITE 1 B
Mailing Address - Street 2:THE CENTER FOR ORAL & MAXILLOFACIAL SURGERY & IMPLANTOL
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1995
Mailing Address - Country:US
Mailing Address - Phone:973-667-5844
Mailing Address - Fax:973-667-6653
Practice Address - Street 1:187 WASHINGTON AVENUE, SUITE 1 B
Practice Address - Street 2:THE CENTER FOR ORAL & MAXILLOFACIAL SURGERY & IMPLANTOL
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1995
Practice Address - Country:US
Practice Address - Phone:973-667-5844
Practice Address - Fax:973-667-6653
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD10169591223S0112X
NJ22DI016959001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ587985MD9Medicare ID - Type Unspecified
U53357Medicare UPIN