Provider Demographics
NPI:1053744136
Name:PHILPOTT, DOMINIC EVAN (DMD)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:EVAN
Last Name:PHILPOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10780 N. WASHINGTON AVE.
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233
Mailing Address - Country:US
Mailing Address - Phone:303-452-6630
Mailing Address - Fax:303-252-0237
Practice Address - Street 1:10780 N. WASHINGTON AVE.
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233
Practice Address - Country:US
Practice Address - Phone:303-452-6630
Practice Address - Fax:303-252-0237
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013022866122300000X
IL019029483122300000X
CO002020611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist