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General NPI Number Information
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NPI Number | 1952381899
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Entity Type | Individual
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Provider Name | NATHAN ALEXANDER PHILLIPS DDS
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Gender | Male
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 301 OAK TREE LN
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City | DAKOTA DUNES
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State | SD
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Zip | 57049
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Country | US
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Telephone | 605-242-0107
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Fax | 605-242-0145
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Provider Business Mailing Address
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Address Line | 301 OAK TREE LN
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5095
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Country | US
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Telephone | 605-242-0107
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Fax | 605-242-0145
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 09366
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D1140
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License Number State | SD
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