Healthcare Provider Details

I. General information

NPI: 1831302124
Provider Name (Legal Business Name): BYRON ERIC PHILLIPS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 JOHNS HOPKINS DR
GREENVILLE NC
27834-7223
US

IV. Provider business mailing address

805 JOHNS HOPKINS DR
GREENVILLE NC
27834-7223
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-6644
  • Fax: 252-752-6828
Mailing address:
  • Phone: 252-752-6644
  • Fax: 252-752-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number8512
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: