Phyllis Horning Detwiler, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI01130400 Issued in NJ

Practice address

110 Marter Ave
Suite 204
Moorestown, NJ 08057-3124

Phone

(856) 727-6453

Fax

(856) 727-4039

NPI assigned

May 23, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Moorestown Dental Associates, LLC

  • Dentist
  • Moorestown, NJ
  • NPI 1912237793
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420243200000",
    "number": "1477556470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 N BREAD ST",
            "address_2": "APARTMENT 2B",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191064610",
            "telephone_number": "732-567-6333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 MARTER AVE",
            "address_2": "SUITE 204",
            "city": "MOORESTOWN",
            "state": "NJ",
            "postal_code": "080573124",
            "telephone_number": "856-727-6453",
            "fax_number": "856-727-4039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETWILER",
        "first_name": "PHYLLIS",
        "middle_name": "HORNING",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-23",
        "last_updated": "2015-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI01130400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "22DI011130400",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dermatology Associates, PA
• Amisha Desai, OD
• Khusbu Desai
• Nipa S Desai, RPH
• Albert Desiderio, PT, DPT
• Sabrina Emily Deyhle, DO
• Dhaliwal Therapeutic Solutions LLC
• Maninder Dhaliwal
• Jasmine Dhanda
• Vincent L. Di Antonio, APN, PMHNP-BC

• General Practice Dentistry in Moorestown, NJ
• Providers in Moorestown, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.