MEDICARE: MISS LAURIE KENDALL PHILLIPPI 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	122300000X	Dentist	30.026514	OH

General Provider Information

NPI Number	:	1952977977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LAURIE KENDALL PHILLIPPI DMD

Provider Business Mailing Address
First Line	:	5221 WAYNETOWNE CT
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-2124
Country	:	US
Telephone Number	:	937-237-0360
Fax Number	:

Provider Business Practice Location Address
First Line	:	5221 WAYNETOWNE CT
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-2124
Country	:	US
Telephone Number	:	937-237-0360
Fax Number	:

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

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	06/02/2021

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