Provider Demographics
NPI:1104970730
Name:PIKE, PHILIP L (DDS)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:L
Last Name:PIKE
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 1:4901 LIMESTONE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1271
Mailing Address - Country:US
Mailing Address - Phone:302-239-0303
Mailing Address - Fax:302-239-6755
Practice Address - Street 1:4901 LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1271
Practice Address - Country:US
Practice Address - Phone:302-239-0303
Practice Address - Fax:302-239-6755
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00009371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000917108Medicaid