Healthcare Provider Details

I. General information

NPI: 1558337311
Provider Name (Legal Business Name): ERIN FUSON PHILLIPS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8433 HARCOURT RD SUITE 307
INDIANAPOLIS IN
46260-2190
US

IV. Provider business mailing address

8433 HARCOURT RD SUITE 307
INDIANAPOLIS IN
46260-2190
US

V. Phone/Fax

Practice location:
  • Phone: 317-872-7272
  • Fax: 317-872-0774
Mailing address:
  • Phone: 317-872-7272
  • Fax: 317-872-0774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1210493A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: