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NPI Code Detail

MEDICARE: DR. DAVID M PHILLIPS D.D.S.

MEDICARE: DR. DAVID M PHILLIPS D.D.S.
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
11223G0001XGeneral Practice DentistryD11114MN
21223S0112XOral and Maxillofacial Surgery (Dentist)D11114MN

General Provider Information

NPI Number : 1154311181
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID M PHILLIPS D.D.S.
Provider Business Mailing Address
First Line : 1406 OSCEOLA AVE
Second Line : APT #204
City : SAINT PAUL
State : MN
Zip : 55105-2348
Country : US
Telephone Number : 651-207-8780
Fax Number :
Provider Business Practice Location Address
First Line : 11237 FOLEY BLVD NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55448-3389
Country : US
Telephone Number : 763-757-3120
Fax Number : 763-757-5161
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 08/07/2014

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