Healthcare Provider Details

I. General information

NPI: 1417090499
Provider Name (Legal Business Name): KENT L. PHILLIPS, D.D.S., M.S., LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 W LAKE MEAD BLVD STE 6
LAS VEGAS NV
89128-1001
US

IV. Provider business mailing address

7550 W LAKE MEAD BLVD STE 6
LAS VEGAS NV
89128-1001
US

V. Phone/Fax

Practice location:
  • Phone: 702-242-9777
  • Fax: 702-242-9265
Mailing address:
  • Phone: 702-242-9777
  • Fax: 702-242-9265

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: OWNER
Credential: D.D.S., M.S.
Phone: 775-332-1750