MEDICARE: DR. DAVID PHELPS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3795	SC

General Provider Information

NPI Number	:	1891790226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID PHELPS DDS

Provider Business Mailing Address
First Line	:	3904 HIGHWAY 86
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29642-9549
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3904 HIGHWAY 86
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29642-9549
Country	:	US
Telephone Number	:	864-850-9100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	08/28/2007

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