Provider Demographics
NPI:1487933842
Name:PHILLIPE, MARK G (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:PHILLIPE
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 1:31571 CANYON ESTATES DR STE 117
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-0471
Mailing Address - Country:US
Mailing Address - Phone:951-244-9495
Mailing Address - Fax:
Practice Address - Street 1:31571 CANYON ESTATES DR STE 117
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-0471
Practice Address - Country:US
Practice Address - Phone:951-244-9495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist