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General NPI Number Information
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NPI Number | 1881236883
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Entity Type | Organization
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Legal Business Name | BLAKE PHILLIPS D.M.D., P.C.
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Dates
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Enumeration Date | 10/10/2019
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 1112 19TH ST S
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City | BIRMINGHAM
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State | AL
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Zip | 35205-4814
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Country | US
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Telephone | 205-933-1331
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 19TH ST S
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City | BIRMINGHAM
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State | AL
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Zip | 35205-4814
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ORAL AND MAXILLOFACIAL SURGEON
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Name | JOSEPH BLAKE PHILLIPS
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Credential | DMD
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Telephone | 205-933-1332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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