MEDICARE: LISA PHILLIPS DDS

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	122300000X	Dentist	12671	TN

General Provider Information

NPI Number	:	1063228658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA PHILLIPS DDS

Provider Business Mailing Address
First Line	:	9775 US HIGHWAY 64
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-8586
Country	:	US
Telephone Number	:	901-810-0414
Fax Number	:

Provider Business Practice Location Address
First Line	:	9775 US HIGHWAY 64 STE 101
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-8587
Country	:	US
Telephone Number	:	901-810-0414
Fax Number	:

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

Provider Enumeration Date	:	12/09/2024
Last Update Date	:	12/10/2025

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