Charles Clayton Phillips III, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

30008 Issued in CA

Practice address

12395 El Camino Real
Ste 304
San Diego, CA 92130-3085

Phone

(858) 793-3393

Fax

(858) 793-3383

NPI assigned

Jul 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Charles Phillips III Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912920745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12395 EL CAMINO REAL STE 304",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303085",
            "telephone_number": "858-793-3393",
            "fax_number": "858-793-3383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12395 EL CAMINO REAL",
            "address_2": "STE 304",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303085",
            "telephone_number": "858-793-3393",
            "fax_number": "858-793-3383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "CHARLES",
        "middle_name": "CLAYTON",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "30008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHARLES",
            "last_name": "PHILLIPS",
            "suffix": "III",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Alma Esteves Phillips, LCSW
• Arthur Phillips, M.D.
• Autumn Rose Phillips, PSY.D.
• Casey Phillips, DIMM
• Charese Amille Phillips
• Cheryl-Anne Maria Phillips, AODS COUNSELOR
• Christopher Ryan Phillips, MD
• Coti Phillips, M.D.
• Delray Phillips
• Devon Dale Phillips

• Oral and Maxillofacial Surgery (Dentist) in San Diego, CA
• Providers in San Diego, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.