Active NPI
Wilson Phillips, DMD
- Dentist
- Prospect Park, PA
National Provider Identifier
1144679499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN002360
- Practice address
- 1319 Lincoln Ave
Prospect Park, PA 19076-1216 - Phone
- (610) 532-5008
- NPI assigned
- Jun 7, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN002360 | PA | Primary |
Addresses
Primary practice location
1319 Lincoln Ave
Prospect Park, PA 19076-1216
Mailing address
626 Snyder Ave
Philadelphia, PA 19148-2419
Phone (267) 940-0300
Other practice location 1
191 Presidential Blvd
Suite W4
Bala Cynwyd, PA 19004-1207
Phone (267) 940-0300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DN002360 | Other | PA | PA STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN002360 | PA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rapozafamily Dentistry | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Prospect Park, PA
- NPI 1710142625
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527811200000",
"number": "1144679499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "626 SNYDER AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191482419",
"telephone_number": "267-940-0300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1319 LINCOLN AVE",
"city": "PROSPECT PARK",
"state": "PA",
"postal_code": "190761216",
"telephone_number": "610-532-5008"
}
],
"practiceLocations": [
{
"address_1": "191 Presidential Blvd",
"address_2": "Suite W4",
"address_purpose": "LOCATION",
"city": "Bala Cynwyd",
"state": "PA",
"postal_code": "190041207",
"country_code": "US",
"telephone_number": "267-940-0300",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PHILLIPS",
"first_name": "WILSON",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-07",
"last_updated": "2018-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DN002360",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA STATE LICENSE NUMBER",
"identifier": "DN002360",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Prospect Park, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.