MEDICARE: DR. JAMES JACKSON PHILLIPS JR. 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	1223G0001X	General Practice Dentistry	4251	AL

General Provider Information

NPI Number	:	1245230150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES JACKSON PHILLIPS JR. DMD

Provider Business Mailing Address
First Line	:	761 N DEAN RD
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36830-4027
Country	:	US
Telephone Number	:	334-821-5291
Fax Number	:	334-821-5292

Provider Business Practice Location Address
First Line	:	761 N DEAN RD
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36830-4027
Country	:	US
Telephone Number	:	334-821-5291
Fax Number	:	334-821-5292

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	06/20/2008

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