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General NPI Number Information
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NPI Number | 1487131488
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Entity Type | Individual
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Provider Name | SYDNEY RAE MCPHILLIPS DDS
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Gender | Female
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Dates
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Enumeration Date | 07/23/2018
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 1090 SHINGLE CREEK XING
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City | BROOKLYN CENTER
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State | MN
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Zip | 55430-2684
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Country | US
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Telephone | 651-724-9933
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Fax |
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Provider Business Mailing Address
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Address Line | 13420 SHENANDOAH ST NE
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City | HAM LAKE
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State | MN
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Zip | 55304-6548
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Country | US
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Telephone | 612-210-7100
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D14094
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License Number State | MN
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