Individual
CHARLES W PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DD
Contact information
Practice address
3449 E REZANOF DR, KODIAK, AK 99615-6952
(907) 486-9800
(907) 486-9898
Mailing address
3449 E REZANOF DR, KODIAK, AK 99615-6952
(907) 486-9800
(907) 486-9898
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1169
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DD5430
—
AK
Enumeration date
10/03/2006
Last updated
07/09/2007
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