Healthcare Provider Details

I. General information

NPI: 1992633754
Provider Name (Legal Business Name): EMILY PHILLIPS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CHERRY AVE
CHARDON OH
44024-1117
US

IV. Provider business mailing address

220 CHERRY AVE
CHARDON OH
44024-1117
US

V. Phone/Fax

Practice location:
  • Phone: 440-286-2474
  • Fax:
Mailing address:
  • Phone: 440-286-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.028413
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: