Provider Demographics
NPI:1063609295
Name:ROE, PHILLIP (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:ROE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 W FRYE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-5132
Mailing Address - Country:US
Mailing Address - Phone:480-542-5617
Mailing Address - Fax:480-542-5618
Practice Address - Street 1:3133 W FRYE RD STE 102
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-5132
Practice Address - Country:US
Practice Address - Phone:480-542-5617
Practice Address - Fax:480-542-5618
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000097101223P0700X
CA527761223P0700X
AZD0102531223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics