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General NPI Number Information
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NPI Number | 1063919744
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Entity Type | Individual
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Provider Name | PHYLLIS KEPHART PHDHP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 501 HOWARD AVE. BUILDING D SUITE 103
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City | ALTOONA
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State | PA
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Zip | 16601-4814
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Country | US
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Telephone | 814-889-6420
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Fax |
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Provider Business Mailing Address
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Address Line | 553 52ND ST
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City | ALTOONA
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State | PA
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Zip | 16602-1446
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Country | US
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Telephone | 814-943-3606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | PHDH000805
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH010609L
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License Number State | PA
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