Healthcare Provider Details

I. General information

NPI: 1306579982
Provider Name (Legal Business Name): DANIEL STEPHEN PHILLIPS, D.D.S., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 W HIGH ST STE 1
ORRVILLE OH
44667-1444
US

IV. Provider business mailing address

1440 W HIGH ST STE 1
ORRVILLE OH
44667-1444
US

V. Phone/Fax

Practice location:
  • Phone: 330-683-1906
  • Fax:
Mailing address:
  • Phone: 330-683-1906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL PHILLIPS
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 330-860-7054