MEDICARE: PHILLIPPI DENTAL 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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1851004923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILLIPPI DENTAL LLC

Provider Business Mailing Address
First Line	:	219 N GALLOWAY ST
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-2303
Country	:	US
Telephone Number	:	937-554-1432
Fax Number	:

Provider Business Practice Location Address
First Line	:	7790 DAYTON SPRINGFIELD RD
Second Line	:
City	:	FAIRBORN
State	:	OH
Zip	:	45324-1996
Country	:	US
Telephone Number	:	937-340-6200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SCOTT BRADFORD PHILLIPPI
Credential	:	DDS
Telephone Number	:	937-554-1432

Provider Enumeration Date	:	01/03/2023
Last Update Date	:	01/03/2023

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