MEDICARE: CODY CLINTON PHEN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	13237	NC

General Provider Information

NPI Number	:	1063100691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY CLINTON PHEN DMD

Provider Business Mailing Address
First Line	:	126 CINEMA DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1490
Country	:	US
Telephone Number	:	910-940-0259
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 CINEMA DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1490
Country	:	US
Telephone Number	:	910-940-0259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	06/30/2026

Similar Medicare Providers

1750432662 — HOWELL SUPPORT SERVICES
Practice Location Address:

106C CINEMA DR
WILMINGTON, NC
28403-1490

Practice Phone: 910-362-0833
Practice Fax: 910-362-0835

1679214035 — KAMP, WALLACE & ASSOCIATES PLLC
Practice Location Address:

126 CINEMA DR
WILMINGTON, NC
28403-1490

Practice Phone: 910-442-3443
Practice Fax:

1164823845 — JEFFREY DIKSA BCBA
Practice Location Address:

500 DELAWARE AVE STE 102
WILMINGTON, DE
19801-1490

Practice Phone: 610-836-2627
Practice Fax:

1588580021 — CASSANDRA GOODSON LMBT
Practice Location Address:

4004 OLEANDER DR STE 101
WILMINGTON, NC
28403-6807

Practice Phone: 910-200-0616
Practice Fax:

1437776499 — ERIN AMIRA WHALING PA-C
Practice Location Address:

3787 SHIPYARD BLVD
WILMINGTON, NC
28403-6148

Practice Phone: 910-332-3800
Practice Fax: 910-251-0421

1124944400 — JADA HARRISON
Practice Location Address:

5027 WRIGHTSVILLE AVE
WILMINGTON, NC
28403-7046

Practice Phone: 888-815-5502
Practice Fax:

Directions to “ CODY CLINTON PHEN DMD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.