Provider Demographics
NPI:1194828129
Name:PHILLIPS, ERIC DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DAVID
Last Name:PHILLIPS
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 1:930 FLORIN RD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5002
Mailing Address - Country:US
Mailing Address - Phone:916-395-1900
Mailing Address - Fax:916-394-7417
Practice Address - Street 1:930 FLORIN RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-5002
Practice Address - Country:US
Practice Address - Phone:916-395-1900
Practice Address - Fax:916-394-7417
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice