Healthcare Provider Details

I. General information

NPI: 1801424049
Provider Name (Legal Business Name): NIKKI KATRINA PHILLIPS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 THOMAS JOHNSON DR
FREDERICK MD
21702-4501
US

IV. Provider business mailing address

1804 CHESTERFIELD CT
FREDERICK MD
21702-2840
US

V. Phone/Fax

Practice location:
  • Phone: 301-631-0501
  • Fax: 301-631-0601
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number17334
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: