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Individual
DR. PHYLLIS HORNING DETWILER
Active
Individual
DR. PHYLLIS HORNING DETWILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI01130400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22DI011130400
DENTAL LICENSE
NJ
Enumeration date
05/23/2005
Last updated
01/03/2015
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