Provider Demographics
NPI:1699181735
Name:GREG PHILSON DDS PC
Entity type:Organization
Organization Name:GREG PHILSON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PHILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-545-6421
Mailing Address - Street 1:830 W ABRIENDO AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1500
Mailing Address - Country:US
Mailing Address - Phone:719-545-6421
Mailing Address - Fax:719-545-6422
Practice Address - Street 1:830 W ABRIENDO AVE
Practice Address - Street 2:830 W ABRIENDO AVE
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1500
Practice Address - Country:US
Practice Address - Phone:719-545-6421
Practice Address - Fax:719-545-6422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO59321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty