Healthcare Provider Details

I. General information

NPI: 1962975755
Provider Name (Legal Business Name): PHILLIPS AND RUST DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 BRIARCLIFF AVE
OAK RIDGE TN
37830-8799
US

IV. Provider business mailing address

649 BRIARCLIFF AVE
OAK RIDGE TN
37830-8799
US

V. Phone/Fax

Practice location:
  • Phone: 865-483-7851
  • Fax: 865-483-6391
Mailing address:
  • Phone: 865-483-7851
  • Fax: 865-483-6391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL JEFFREY PHILLIPS
Title or Position: DENTIST
Credential: DDS
Phone: 865-483-7851