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NPI Code Detail

MEDICARE: SCOTT B PHILLIPPI DDS LLC

MEDICARE: SCOTT B PHILLIPPI DDS LLC
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
1261QD0000XDental Clinic/Center30022577OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11649479643OTHEROHINDIVIDUAL NPI

General Provider Information

NPI Number : 1649666355
Entity Type Code : Organization
Provider Name (Legal Business Name) : SCOTT B PHILLIPPI DDS LLC
Provider Business Mailing Address
First Line : 5221 WAYNETOWNE CT
Second Line :
City : HUBER HEIGHTS
State : OH
Zip : 45424-2124
Country : US
Telephone Number : 937-237-0360
Fax Number : 937-237-2707
Provider Business Practice Location Address
First Line : 5221 WAYNETOWNE CT
Second Line :
City : HUBER HEIGHTS
State : OH
Zip : 45424-2124
Country : US
Telephone Number : 937-237-0360
Fax Number : 937-237-2707
Authorized Official
Title or Position : OWNER
Name : DR. SCOTT BRADFORD PHILLIPPI
Credential : DDS
Telephone Number : 937-554-0861
Provider Enumeration Date : 04/09/2015
Last Update Date : 04/09/2015

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