MEDICARE: LEE ROY 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
1	1223G0001X	General Practice Dentistry	DS017889L	PA

General Provider Information

NPI Number	:	1184771230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE ROY PHILLIPS D.D.S.

Provider Business Mailing Address
First Line	:	9655 LONGSWAMP RD
Second Line	:
City	:	MERTZTOWN
State	:	PA
Zip	:	19539-8800
Country	:	US
Telephone Number	:	610-682-6386
Fax Number	:	610-682-6387

Provider Business Practice Location Address
First Line	:	9655 LONGSWAMP RD
Second Line	:
City	:	MERTZTOWN
State	:	PA
Zip	:	19539-8800
Country	:	US
Telephone Number	:	610-682-6386
Fax Number	:	610-682-6387

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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