MEDICARE: DR. GARRETT EVAN PHIPPS 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	22810	TX

General Provider Information

NPI Number	:	1306015250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARRETT EVAN PHIPPS D.D.S.

Provider Business Mailing Address
First Line	:	3609 S GEORGIA ST
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79109-4847
Country	:	US
Telephone Number	:	806-358-7471
Fax Number	:	806-358-1883

Provider Business Practice Location Address
First Line	:	3609 S GEORGIA ST
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79109-4847
Country	:	US
Telephone Number	:	806-358-7471
Fax Number	:	806-358-1883

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

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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