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General NPI Number Information
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NPI Number | 1235594292
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Entity Type | Individual
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Provider Name | ANDREA ROSE PHILLIPS RDH
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Gender | Female
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Dates
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Enumeration Date | 12/17/2015
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | JUNCTION RD 371 RT 9
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City | CROWNPOINT
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State | NM
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Zip | 87313
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Country | US
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Telephone | 505-786-6283
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Fax |
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Provider Business Mailing Address
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Address Line | JUNCTION RD 371 RT 9 PO BOX 358
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City | CROWNPOINT
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State | NM
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Zip | 87313
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Country | US
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Telephone | 505-786-6283
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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 | H9313
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License Number State | MN
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