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General NPI Number Information
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NPI Number | 1760041248
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Entity Type | Individual
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Provider Name | BRIANNA L PHILLIPS DDS
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Gender | Female
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 1607 E RAINFOREST RD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5385
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Country | US
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Telephone | 479-582-0600
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Fax | 417-845-0094
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Provider Business Mailing Address
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Address Line | 3004 SW HAZELNUT AVE
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City | BENTONVILLE
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State | AR
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Zip | 72713
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Country | US
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Telephone | 417-438-9133
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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 | 2019019148
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License Number State | MO
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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 | 4382
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License Number State | AR
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