MEDICARE: DR. PHILLIP A KISSINGER DMD

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	5939	KY

General Provider Information

NPI Number	:	1982674610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP A KISSINGER DMD

Provider Business Mailing Address
First Line	:	221 TRELLIS ST
Second Line	:
City	:	ALVATON
State	:	KY
Zip	:	42122-8756
Country	:	US
Telephone Number	:	270-303-6989
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 TRELLIS ST
Second Line	:
City	:	ALVATON
State	:	KY
Zip	:	42122-8756
Country	:	US
Telephone Number	:	270-303-6989
Fax Number	:

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	02/27/2013

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