=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598891251
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHILIP KELLY BILES DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 306 E LINCOLN ST
-----------------------------------------------------
City | TULLAHOMA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37388-3750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-455-6664
-----------------------------------------------------
Fax | 931-455-6655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 306 E LINCOLN ST
-----------------------------------------------------
City | TULLAHOMA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37388-3750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-455-6664
-----------------------------------------------------
Fax | 931-455-6655
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS2838
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------