NPIMap

Organization Active NPI

Phyllis H. Detwiler DMD PC

  • Dentist
  • Red Bank, NJ
National Provider Identifier
1851517825
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DI011304 Issued in NJ
Legal business name
PHYLLIS H. DETWILER DMD PC
Practice address
429 State Route 35
Red Bank, NJ 07701-5914
Phone
(732) 345-8460
NPI assigned
Apr 18, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Phyllis Horning Detwiler, DMD
Title
Owner Dentist
Phone
(732) 345-8460

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DI011304 NJ Primary

Addresses

Primary practice location

429 State Route 35
Red Bank, NJ 07701-5914

Mailing address

429 State Route 35
Red Bank, NJ 07701-5914
Phone (732) 345-8460

National Provider Directory

National Provider Directory

Locations

429 State Route 35
Red Bank, NJ 07701
Phone (732) 345-8460

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851517825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "429 STATE ROUTE 35",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077015914",
            "telephone_number": "732-345-8460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 STATE ROUTE 35",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077015914",
            "telephone_number": "732-345-8460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYLLIS H. DETWILER DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DETWILER",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "HORNING",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "732-345-8460",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "DI011304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Bank, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.