Healthcare Provider Details

I. General information

NPI: 1760041248
Provider Name (Legal Business Name): BRIANNA L PHILLIPS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA L DAVIDSON DDS

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 E RAINFOREST RD
FAYETTEVILLE AR
72703-5385
US

IV. Provider business mailing address

3004 SW HAZELNUT AVE
BENTONVILLE AR
72713
US

V. Phone/Fax

Practice location:
  • Phone: 479-582-0600
  • Fax: 417-845-0094
Mailing address:
  • Phone: 417-438-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2019019148
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4382
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: