MEDICARE: DR. MICHAEL STEVEN PHILLIPS D.M.D.

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	1223G0001X	General Practice Dentistry	17477	MA

General Provider Information

NPI Number	:	1104885250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL STEVEN PHILLIPS D.M.D.

Provider Business Mailing Address
First Line	:	2105 SANDY POINT LN
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-8770
Country	:	US
Telephone Number	:	843-654-9743
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 W HILL BLVD
Second Line	:	628TH MEDICAL GROUP DENTAL SERVICES
City	:	CHARLESTON AFB
State	:	SC
Zip	:	29404-4704
Country	:	US
Telephone Number	:	843-963-6822
Fax Number	:

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

Provider Enumeration Date	:	03/18/2006
Last Update Date	:	03/25/2013

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