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NPI Code Detail

MEDICARE: DR. LAURYN PATRICE PHILLIPS D.D.S.

MEDICARE: DR. LAURYN PATRICE 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
1122300000XDentistDN014658GA

General Provider Information

NPI Number : 1619301207
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURYN PATRICE PHILLIPS D.D.S.
Provider Business Mailing Address
First Line : 4409 LUXEMBOURG WAY
Second Line :
City : DECATUR
State : GA
Zip : 30034-5433
Country : US
Telephone Number : 770-778-4842
Fax Number :
Provider Business Practice Location Address
First Line : 5461 HILLANDALE DR
Second Line : AUITE 200
City : LITHONIA
State : GA
Zip : 30058-4841
Country : US
Telephone Number : 770-778-4842
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2013
Last Update Date : 08/30/2013

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