Healthcare Provider Details

I. General information

NPI: 1972918159
Provider Name (Legal Business Name): JUDY A PHILIP DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 S HIGHWAY 77
NEWKIRK OK
74647-7009
US

IV. Provider business mailing address

212 N MAIN ST
FAIRFAX OK
74637-3023
US

V. Phone/Fax

Practice location:
  • Phone: 580-362-2555
  • Fax: 580-362-2948
Mailing address:
  • Phone: 918-642-3100
  • Fax: 918-642-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6624
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: