Provider Demographics
NPI:1104252154
Name:WORTHINGTON, PHILIP M (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:M
Last Name:WORTHINGTON
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 1:13271 STRICKLAND RD # GLADWELL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-5227
Mailing Address - Country:US
Mailing Address - Phone:919-923-8513
Mailing Address - Fax:
Practice Address - Street 1:13271 STRICKLAND RD # GLADWELL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-5227
Practice Address - Country:US
Practice Address - Phone:919-923-8513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC108091223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice