Healthcare Provider Details

I. General information

NPI: 1720107576
Provider Name (Legal Business Name): JAMES LEE PHILLIPS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 NORTH OHIO AVENUE
WELLSTON OH
45692-0266
US

IV. Provider business mailing address

PO BOX 266
WELLSTON OH
45692-0266
US

V. Phone/Fax

Practice location:
  • Phone: 740-384-6888
  • Fax:
Mailing address:
  • Phone: 740-384-6888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberOH17194
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: