| Organization Name: | KEITH PHILLIPS, DMD, MSD, PS, INC |
| NPI Number: | 1497091243 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEITH MARTIN PHILLIPS (OWNER) |
| Mailing Address: | 5619 Valley Ave E Fife |
| State: | WA US |
| Postal Code: | 984242060 |
| Phone Number: | 2539225519 |
| Fax Number: | 2539222719 |
| NPI Enumeration Date: | 12/26/2012 |
| NPI Last Update Date: | 12/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | DE00007693 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |