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General NPI Number Information
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NPI Number | 1326018508
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Entity Type | Individual
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Provider Name | BILLY JAMES PHILLIPS DDS
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Gender | Male
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | H 2005 KNIGHT LANE NAVY MEDICINE SUPPORT COMMAND, ATTN: MEDICAL STAFF SERV
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City | JACKSONVILLE
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State | FL
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Zip | 32212-0140
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Country | US
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Telephone | 904-542-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 34800 BOB WILSON DR
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City | SAN DIEGO
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State | CA
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Zip | 92134-1098
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Country | US
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Telephone | 619-532-5832
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | MILITARY EXEMPT STAT
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401008067
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number | 0401008067
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License Number State | VA
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