Healthcare Provider Details

I. General information

NPI: 1659406395
Provider Name (Legal Business Name): KENT L. PHILLIPS, D.D.S., M.S., LTB.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N STEPHANIE ST SUITE 104
HENDERSON NV
89014-8028
US

IV. Provider business mailing address

390 N STEPHANIE ST SUITE 104
HENDERSON NV
89014-8028
US

V. Phone/Fax

Practice location:
  • Phone: 702-565-4646
  • Fax: 702-565-7069
Mailing address:
  • Phone: 702-565-4646
  • Fax: 702-565-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KENT L PHILLIPS
Title or Position: DOCTOR
Credential: D.D.S.,M.S.
Phone: 775-332-1750