Provider Demographics
NPI:1285158949
Name:PHILLIPS, JOSEPH DOUGLAS (DDS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DOUGLAS
Last Name:PHILLIPS
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 1:10737 CAMINO RUIZ STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2363
Mailing Address - Country:US
Mailing Address - Phone:858-578-1822
Mailing Address - Fax:
Practice Address - Street 1:10737 CAMINO RUIZ STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2363
Practice Address - Country:US
Practice Address - Phone:858-578-1822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101727122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist