Healthcare Provider Details

I. General information

NPI: 1881912376
Provider Name (Legal Business Name): JESSICA MEGAN PHILLIPS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 CALLAHAN DR
KNOXVILLE TN
37912-1310
US

IV. Provider business mailing address

1103 CALLAHAN DR
KNOXVILLE TN
37912-1310
US

V. Phone/Fax

Practice location:
  • Phone: 865-859-0355
  • Fax:
Mailing address:
  • Phone: 865-859-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8904
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9446
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: